Devices and methods for providing surgical access

ABSTRACT

Adjustable-length surgical access devices are disclosed herein, which can advantageously allow an overall length of the access device to be quickly and easily changed by the user. The access devices herein can reduce or eliminate the need to maintain an inventory of many different length access devices. In some embodiments, the length of the access device can be adjusted while the access device is inserted into the patient. This can reduce or eliminate the need to swap in and out several different access devices before arriving at an optimal length access device. This can also reduce or eliminate the need to change the access device that is inserted into a patient as the depth at which a surgical step is performed changes over the course of a procedure. Rather, the length of the access device can be adjusted in situ and on-the-fly as needed or desired to accommodate different surgical depths.

CROSS REFERENCE TO RELATED APPLICATION

The present application is a continuation of U.S. application Ser. No.15/786,858, filed on Oct. 18, 2017. U.S. application Ser. No. 15/786,858claims priority to U.S. Provisional Application No. 62/468,475 filed onMar. 8, 2017. U.S. application Ser. No. 15/786,858 is also acontinuation-in-part of U.S. application Ser. No. 15/437,792 filed onFeb. 21, 2017. U.S. application Ser. No. 15/437,792 is acontinuation-in-part of U.S. application Ser. No. 15/254,877 filed onSep. 1, 2016. U.S. application Ser. No. 15/254,877 claims priority toU.S. Provisional Application No. 62/214,297 filed on Sep. 4, 2015. Theentire contents of these applications are incorporated by referenceherein.

FIELD

The present application relates to devices and methods for providingsurgical access, e.g., using adjustable length surgical access devices.

BACKGROUND

Traditionally, incisions are made into a patient's body in order toaccess a patient's surgical region. Often, these incisions are madelarge enough to accommodate the insertion and removal of variousimplants, instruments and other objects. Such incisions provideunrestricted access through the patient's skin, and to the patient'sanatomy at and around the surgical region. Such free access to andmovement within the patient's body may provide certain advantages, butcan increase the invasiveness of the procedure and can expose thepatient to additional risks, for example, due to the various movingobjects during surgery undesirably making contact with the patient, forexample, at areas other than the surgical site.

To this end, access systems such as tubular access ports have beendeveloped to provide enhanced targeting and accuracy to the patient'ssurgical region of interest. These ports can be used inminimally-invasive or percutaneous surgical procedures. For instance,microsurgical spinal bone resections and spinal decompressions, to namea few surgical procedures, are performed under microscopic view throughopenings in miniature percutaneous tubular access ports. Rather thaninserting implants, instruments, objects, and even body parts (e.g.,surgeon's hands) freely into the patient's body via the incision, thetubular access port is inserted through the incision and stabilized ator near the patient's surgical region, leaving a proximal end of thetubular access port accessible from above the patient's skin. Onceinserted, the tubular access port provides a working channel from thepatient's skin to the surgical site and protects and prevents trauma to,for example, bone, tissue, and nerves by objects being moved to and fromthe surgical site through the access port.

These tubular access ports are designed to have lengths capable ofreaching the surgical region while being accessible from outside of thepatient's skin or incision. Because the tubular access port is used forvarious surgeries, in order to access a number of surgical regionslocated at varying depths in the patient's body, traditional tubularaccess ports are manufactured in many sizes to achieve the desiredsurgical objective. Manufacturers of these access ports are thus taskedwith developing and maintaining adequate supplies of a large variety ofaccess tubes, each of which can have varying specifications (e.g.,lengths). Adequate machinery and human supervision is required tooversee the manufacturing of a large and diverse portfolio of accessports. Likewise, traditional surgical centers such as hospitals are leftwith the burden of purchasing and storing a large and diverse inventoryof access ports, in order to be prepared to use the adequate-lengthaccess port for any surgery at any given time.

SUMMARY

Adjustable-length surgical access devices are disclosed herein, whichcan advantageously allow an overall length of the access device to bequickly and easily changed by the user. The access devices herein canreduce or eliminate the need to maintain an inventory of many differentlength access devices. In some embodiments, the length of the accessdevice can be adjusted while the access device is inserted into thepatient. This can reduce or eliminate the need to swap in and outseveral different access devices before arriving at an optimal lengthaccess device. This can also reduce or eliminate the need to change theaccess device that is inserted into a patient as the depth at which asurgical step is performed changes over the course of a procedure.Rather, the length of the access device can be adjusted in situ andon-the-fly as needed or desired to accommodate different surgicaldepths.

In some embodiments, an access device can include an upper tube havingan opening formed therethrough, the upper tube including: a proximal endconfigured to prevent proximal movement of a spring, the spring formingan opening through which the upper tube is disposed; and one or morefingers formed at a distal end of the upper tube and extending toward aproximal end of the upper tube, the one or more fingers having ribsformed on an inner surface thereof; a middle tube having an openingformed therethrough for slidably receiving the upper tube, the middletube including a proximal end configured to apply force on the spring;and a lower tube slidably disposed at least in part within the distalend of the upper tube and having an opening formed therethrough, thelower tube including grooves disposed on at least a portion of an outersurface of the lower tube and configured to engage with the ribs on theinner surface of the one or more fingers of the upper tube; wherein themiddle tube is biased away from the upper tube in a configuration inwhich the spring is uncompressed, causing the distal end of the middletube to compress the one or more fingers of the upper tube and lock theposition of the lower tube by engaging the ribs on the inner surface ofthe fingers with the grooves on the outer surface of the lower tube,restricting the proximal and distal movement of the lower tube relativeto the upper tube, and wherein the access device is actuated byproximally moving the middle tube relative to the upper tube against thebias of the spring, causing the one or more fingers to become exposedand move away from the lower tube, and enabling proximal and distalmovement of the lower tube relative to the upper tube.

The openings formed through one or more of the upper tube, the middletube and the lower tube can be round, square or rectangular openings.One or more of the upper tube, middle tube and lower tube can haveround, square or rectangular shapes formed by their outer surfaces. Toprevent the proximal movement of the spring, the proximal end of theupper tube can include a stop portion having an outer surface with acircumference larger than a circumference of an adjacent portion of theupper tube. The stop portion can be configured to prevent proximalmovement of the spring relative to the distal end of the upper tube, andto cause the spring to compress when force is applied thereto in aproximal direction by the proximal end of the middle tube. The middletube can include one or more handles extending away from an outersurface of the proximal end of the middle tube. The proximal movement ofthe middle tube can be caused by the application of force, in a proximaldirection, on the one or more handles. The one or more fingers can bedefined by slits formed through the outer and inner surfaces of theupper tube at its distal end. The grooves on the inner surface of thefingers of the upper tube can be configured to mate with the grooves onthe outer surface of the lower tube, to restrict the proximal and distalmovement of the lower tube relative to the upper tube. The size of theopening of the upper tube at its distal end when the fingers of theupper tube are compressed can be smaller than or equal to the size ofthe lower tube at its proximal end. The size of the opening of the uppertube at its distal end when the fingers of upper tube are flanged can belarger than the size lower tube at its proximal end. The size of theopening of the middle tube can be: (i) larger than the size of the uppertube at its distal end; (ii) larger than the size of the lower tube; and(iii) smaller than the size of the spring. A length of the access devicecan be adjustably set by the locked position of the lower tube in whichits proximal and distal movement relative to the upper tube isrestricted by the engagement of the grooves on the inner surface of thefingers with the grooves on the outer surface of the lower tube.

In some embodiments, a method for operating an access device can includeidentifying a target depth required to access a surgical site in apatient's body; adjusting the length of a surgical access device basedon the identified target depth; and advancing a distal end of thesurgical access device toward the surgical site in the patient's body.

Adjusting of the length of the surgical access device can includeadvancing the surgical access device from a biased configuration to anactuated configuration, to allow distal and proximal sliding of a lowertube of the access device relative to an upper tube of the accessdevice; sliding the lower tube to a target position relative to theupper tube; and advancing the surgical access device from the actuatedconfiguration to the biased configuration, to lock the target positionof the lower tube relative to the upper tube. The advancing of thesurgical access device from the biased configuration to the actuatedconfiguration can include causing one or more fingers disposed on thedistal end of the lower tube to flange by applying one or more of (i)distal force on the upper tube, and (ii) proximal force on the middletube, against the bias of a spring positioned between a proximal end ofthe upper tube and a proximal end of the middle tube, causing the middletube to slide proximally toward the proximal end of the upper tube,wherein, in the actuated configuration, the flanged fingers have anopening configured to enable the lower tube to slide distally andproximally therein. The advancing of the surgical access device from theactuated configuration to the biased configuration can include releasingthe distal force on the upper tube or the proximal force on the middletube, causing the spring to bias to its uncompressed configuration anddriving the middle tube distally away from the proximal end of the uppertube, such that the fingers of the upper tube are compressed by theinner surface of the middle tube, and causing grooves disposed on aninner surface of the fingers of the upper tube to mate with groovesdisposed on an outer surface of the lower tube to prevent the distal andproximal movement of the lower tube relative to the upper tube.

The method can include delivering a material to the surgical sitethrough an opening formed through the surgical access device, thematerial including one or more of: (i) a flowable material selected fromthe group consisting of hemostat and gelatin, and (ii) a powderedmaterial selected from the group consisting of powdered pig bladder,pixie dust, and pixie power.

In some embodiments, a surgical access device can include an inner tube;and an outer tube having a distal end and a proximal end, and a holeformed therethrough, the hole being configured to receive the innertube, wherein an external surface of the inner tube generates frictionwith the internal surface of the outer tube, and wherein movement of theinner tube distally and proximally relative to the outer tube isrestricted by the friction generated by the external surface of theinner tube with the internal surface of the outer tube.

In some embodiments, an access device can include a tube having anopening formed therethrough from a distal end to a proximal end of thetube, the tube comprising one or more sets of cut regions along anexternal surface of the tube for separating the tube into a useableportion and a disposable portion, wherein the useable portion has alength configured to surgically access an area of a patient's body.

The sets of cut regions can include one or more perforations. The setsof cut regions can be provided at fixed intervals along a portion of thelength of the tube. Each of the sets of cut regions can be providedaround the circumference of the external surface of the tube. Each ofthe sets of cut regions can be provided around less than the entirecircumference of the external surface of the tube. Each of theperforations can penetrate through the tube from the external surface tothe internal surface.

The access device can include a ring portion comprising two or moreconcentric walls extending from a proximal end to a distal end of thering portion, the two or more concentric walls being separated by aspace configured to receive the proximal end of the tube. One of the twoor more concentric walls can include one or more teeth features angledfacing the proximal end of the ring portion. The one or more teeth canbe configured to penetrate the external surface of the proximal end ofthe tube when the ring portion is in a mounted configuration. The ringportion can be placed in the mounted configuration by (i) sliding thetube between two of the two or more concentric walls, one of whichincludes the one or more teeth features, from the distal end of the ringportion toward the proximal end of the ring portion, and (ii) pullingthe tube from the proximal end of the ring portion toward the distal endof the ring portion, causing the penetration of the one or more teethinto the external surface of the tube. The one of the two or more wallsincluding the one or more teeth features can have the one or more teethfeatures disposed on a surface facing another of the two or moreconcentric walls. The two or more concentric walls can include anexterior wall, an interior wall and a middle wall provided between theexterior wall and the interior wall. The middle wall can be the one ofthe two or more concentric walls that includes the one or more teethfeatures. The one or more teeth features can be provided on an internalsurface of the middle wall.

In some embodiments, a method of operating an access device can includeidentifying a target depth required to access a surgical site in apatient's body; adjusting the length of a surgical access device basedon the identified target depth; and advancing a distal end of thesurgical access device toward the surgical site in the patient's body.

The adjusting the length of the surgical device can include removing adisposable portion of a tube of the surgical access device, byseparating the disposable portion from the rest of the tube. Theseparating of the disposable portion can include twisting, bending orapplying force against opposite sides of the tube of the surgical accessdevice relative to a fixed pivot point. The fixed pivot point can belocated at one of a set of cut regions disposed on the external surfaceof the tube. The set of cut regions can include one or moreperforations. Each of the sets of cut regions can be provided around thecircumference of the external surface of the tube. Each of theperforations can penetrate through the tube from the external surface tothe internal surface.

The method can include mounting a tube of the adjusted-length surgicaldevice onto a ring portion. The mounting of the tube onto the ringportion can include sliding the proximal end of the tube in a distal endof the ring portion, toward a proximal end of the ring portion, theproximal end of the tube being slid between two walls of the ringportion; pulling the tube in a direction from the proximal end of thering portion toward the distal end of the ring portion, wherein thepulling of the tube causes the teeth features disposed on a surface of afirst wall among the two walls to grip the tube by penetrating into anexternal surface of the tube, the teeth features being disposed on thesurface of the first wall facing a second wall among the two walls. Themethod can include stabilizing the surgical access device advanced intothe surgical site of the patient's body by connecting a stabilizingfeature of the ring portion to a corresponding stabilizing feature on ananchor device.

In some embodiments, a surgical access device can include an inner tubehaving an opening formed therethrough and a knob protruding from anexternal surface of the inner tube; and an outer tube having an openingformed therethrough and one or more slots connected by a path, the oneor more slots and the path penetrating through an external and internalsurface of the outer tube and being operable to receive the knob of theinner tube, wherein rotating the inner tube in a first directionrelative to the outer tube causes the inner tube to be positioned in anadjustable-length configuration, in which the knob of the inner tube isslidably disposed along the path of the outer tube, and wherein rotatingthe inner tube in a second direction opposite the first directionrelative to the outer tube causes the inner tube to be positioned in afixed-length configuration, in which the knob of the inner tube isfixedly engaged within one of the one or more slots of the outer tube.

A proximal end of the inner tube can include a handle, the handle beingoperable to control the rotating of the inner tube in the first andsecond directions. The opening of the outer tube can be configured toreceive a first surgical tool. The outer tube can include a sub-tubeprotruding from the external surface thereof, the sub-tube beingconfigured to receive a second surgical tool. The inner tube in theadjustable-length configuration can be advanced distally and proximallysuch that the knob slides along the path of the outer tube. Fixing theknob of the inner tube in each of the slots of the outer tube can causethe length of the surgical access device to be altered.

In some embodiments, a method for operating a surgical access device caninclude identifying a target depth required to access a surgical site ina patient's body; adjusting the length of a surgical access device basedon the identified target depth; and advancing a distal end of thesurgical access device toward the surgical site in the patient's body.

The adjusting the length of the surgical access device can includerotating an inner tube of the surgical access device in first directionrelative to an outer tube of the surgical access device, to position aknob protruding from an external surface of the inner tube within a pathformed along the length of an outer tube, the inner tube being slidablyengaged within the outer tube; advancing the inner tube distally orproximally relative to the outer tube, such that the knob of the innertube slides along the path of the outer tube; rotating the inner tube ina second direction opposite the first direction relative to the outertube, to position the knob of the inner tube within one of a pluralityof slots formed along the length of the outer tube and extending fromthe path, wherein the positioning of the knob of the inner tube withinone of the plurality of slots causes the proximal and distal position ofthe inner tube relative to the outer tube to be fixed.

In some embodiments, a surgical access device can include an inner tubeincluding one or more engagement features of a first type disposed on anouter surface thereof; and an outer tube telescopically mated with theinner tube, and including one or more engagement features of a secondtype formed at least on the inner surface thereof; wherein the firsttype of engagement features and the second type of engagement featuresare complementary to each other, and wherein a length of the surgicalaccess device is adjusted by one of: (i) rotating the inner tuberelative to the outer tube such that the one or more engagement featuresof the inner tube slide along the corresponding one or more engagementfeatures of the outer tube, and (ii) applying opposite proximal ordistal forces on the inner tube and outer tube, thereby causingengagement features of the inner tube to slip from the corresponding oneor more engagement features of the outer tube to adjacent others of theone or more engagement feature of the outer tube.

The one or more engagement features of the inner tube and the outer tubecan form oblique angles relative to a longitudinal axis of the innertube and/or the outer tube. The one or more engagement features of theinner tube and the outer tube can be formed of a deformable materialenabling their slipping therebetween. The one or more engagementfeatures of the inner tube and the outer tube can be formed around partor all of the circumference of the inner tube and the outer tube,respectively.

In some embodiments, a surgical access device can include an inner tubehaving a distal end, a proximal end, and an opening formed therethrough,the inner tube comprising one or more ratchet features disposed alongpart of a length of an exterior surface of the inner tube, the one ormore ratchet features comprising one or more tooth features; and anouter tube having a distal end, a proximal end, and an opening formedtherethrough, the opening at the proximal end of the outer tube beingconfigured to receive the distal end of the inner tube, and the outertube comprising a lip feature formed around the circumference of theproximal end of the outer tube, the lip feature being configured toengage with one or more of the tooth features of the one or more ratchetfeatures of the inner tube, wherein a length of the surgical accessdevice is adjusted by applying opposite proximal and distal forces onthe inner and outer tubes causing the lip feature of the outer tube toslip over one or more of the tooth features of the one or more ratchetfeatures of the inner tube.

Engaging the lip feature of the outer tube with one or more of the toothfeatures of the inner tube can cause the distal and proximal movement ofthe inner and outer tube, relative to each other, to be restricted. Theproximal end of the inner tube can be cone-shaped and can flangeproximally and externally relative to the rest of the of the inner tube.The external surface of the cone shaped portion of the inner tube can beconfigured to contact a surface of skin of a patient's body when thesurgical access device is inserted in the patient's body. Acircumference of the internal surface of the outer tube at the lipfeature can be smaller than a circumference of the external surface ofthe inner tube at the one or more tooth features.

The access device can include an auxiliary tool comprising a handleportion formed at a proximal end thereof, two or more prongs, and two ormore tabs formed at corresponding distal ends of the two or more prongs,and the two or more prongs biased apart from one another, wherein theinner tube comprises one or more slots formed along part of the lengthof the inner tube, through the external and internal surfaces of theinner tube, wherein the outer tube comprises one or more slots formedalong part of the length of the outer tube, through the external andinternal surface of the outer tube, the one or more slots of the outertube being shorter than the one or more slots of the inner tube, andwherein the auxiliary tool is engaged with the inner and outer tubes bysqueezing the two or more prongs against their bias, proximally anddistally moving the auxiliary tool along the opening of the inner tube,and releasing the two or more prongs causing their tabs to extendthrough the one or more slots of the inner tube and the one or moreslots of the outer tube. The length of the surgical access device can beadjusted by proximally pulling or distally pushing the auxiliary toolwhen the tabs are extending through the one or more slots, causingdistal or proximal force to be applied on the one or more slots of theouter tube and the distal and proximal position of the outer tuberelative to the inner tube to change as the tabs slide along the one ormore slots of the inner tube. The proximal pulling or the distal pushingof the auxiliary tool can cause the lip feature of the outer tube toslip over one or more of the tooth features of the inner tube.

In some embodiments, a method for adjusting a length of a surgicalaccess device can include applying opposite distal and proximal forceson an inner tube and an outer tube of the surgical access device, theinner tube being slidably disposed within an opening of the outer tube,wherein the applying of the opposite distal and proximal forces causes alip feature on an internal surface of a proximal end of the outer tubeto slip past one or more tooth features of one or more ratchet featuresformed on an external surface of the inner tube; and terminating theopposite distal and proximal forces on the inner tube and the outer tubewhen the lip feature of the outer tube is engaged with one or more ofthe tooth features at a position in which the length of the surgicalaccess device is equal to a desired length.

In some embodiments, a method for adjusting a length of a surgicalaccess device can include applying distal or proximal force on anauxiliary tool positioned within an opening formed through an innertube, the auxiliary tool comprising two or more prongs and or two ormore corresponding tabs extending outwardly from distal ends of the twoor more prongs through two or more slots formed through the inner tubeand two or more slots formed through the outer tube, the two or moreslots formed through the outer tube being shorter than the two or moreslots formed through the inner tube, wherein applying the distal orproximal force on the auxiliary tool causes the two or more tabs to pushor pull, respectively, against distal or proximal edges of the slots,such that the outer tube slides distally or proximally relative to theinner tube as the two or more tabs move distally or proximally along theone or more slots of the inner tube.

The applying the distal or proximal force on the auxiliary tool canfurther cause a lip feature formed on an internal surface of a proximalend of the outer tube to skip over one or more tooth features of one ormore ratchet features formed on an external surface of the inner tube.The distal and proximal movement of the outer tube relative to the innertube can be restricted when the lip feature of the outer tube is engagedwith one or more of the tooth features of the inner tube. The auxiliarytool can be positioned within the opening of the inner tube by: inwardlysqueezing the two or more prongs against their bias, such that thedistance between the two or more prongs is less than the diameter of theopening of the inner tube; distally or proximally moving the auxiliarytool within the opening of the inner tube; and releasing the two or moreprongs such that their bias causes the two or more tabs of the two ormore prongs to separate and extend through the two or more slots formedin the inner tube and the two or more slots formed in the outer tube.

In some embodiments, a surgical access device can include a tube-shapedbody having an external surface and an internal surface, the internalsurface forming an opening through the surgical access device from adistal end to a proximal end; a plurality of longitudinal slits formedthrough the body, extending distally from the proximal end; and aplurality of bendable arms formed longitudinally through the body of thesurgical access device, extending distally from the proximal end, eachof the plurality of bendable arms being defined by two of the pluralityof slits, wherein the plurality of bendable arms are configured to beexternally bent relative to a pivot point to adjust the length of theaccess device.

The access device can include a ring wrapped around the external surfaceof the body, wherein the plurality of bendable arms are bent over aproximal end of the ring. The access device can include a stabilizationmaterial for fixing the position of the plurality of bendable arms onskin of a patient, the stabilization material comprising one or more ofsutures, adhesive or tape. At least one of the plurality of bendablearms can engage with one or more posts having a fixed position relativeto the body of a patient, the posts restricting the rotation of the oneof the plurality of bendable arms.

In some embodiments, a method for adjusting a length of a surgicalaccess device can include inserting a distal end of a surgical accessdevice into a body of a patient, the surgical access device having atube-shaped body; sliding a support ring distally along the body of thesurgical access device such that a proximal end of the support ring ispositioned above the surface of the skin of the patient; and bending oneor more bendable arms against the proximal end of the support ring suchthat external surfaces of the one or more bendable arms are placed incontact with the skin of the patient, wherein the one or more bendablearms are formed longitudinally along the body of the surgical accessdevice, extending distally from the proximal end of the surgical accessdevice, the one or more bendable arms being separated by slitspenetrating through the body of the surgical access device.

The one or more bendable arms can be secured to skin using astabilization object including one or more of an adhesive, tape andsutures. At least one of the one or more bendable arms can be positionedbetween two or more posts having a fixed position relative to the bodyof the patient, such that rotation of the at least one of the one ormore bendable arms is prevented.

In some embodiments, a surgical access device can include an inner tubehaving a distal end and a proximal end, a hole formed therethrough fromthe distal end to the proximal end, and one or more first ribbedfeatures wrapped around the circumference of at least part of anexternal surface of the inner tube; and an outer tube having a distalend and a proximal end, a hole formed therethrough from the distal endto the proximal end, and one or more second ribbed features wrappedaround the circumference of at least part of an internal surface of theouter tube, the outer tube having the inner tube slidably engagedtherein, wherein the one or more first ribbed features are configured toengage with the one or more second ribbed features, and wherein a lengthof the surgical access device is adjusted by applying opposite distaland proximal forces on the inner and outer tubes such that at least oneof the one or more first ribbed features slips over at least one of theone or more second ribbed features.

The distal and proximal positions of the inner and outer tube, relativeto each other, can be fixed when the one or more first ribbed featuresare engaged with the one or more second ribbed features. The one or morefirst ribbed features and the one or more second ribbed features can beconvex or concave structures. The access device can include a collarfeature operable to connect to a stabilization object having a fixedposition relative to a body of a patient or an object.

In some embodiments, a method for adjusting the length of a surgicalaccess device can include applying a force to a first tube of thesurgical access device, the force being a distal or proximal forcerelative to a second tube of the surgical access device; causing one ormore ribbed features of the first tube to slide past one or more ribbedfeatures of the second tube; and releasing the force applied to thefirst tube when the first tube has reached a position, relative to thesecond tube, in which a length of the surgical access device is equal toa target length.

The first tube can be an inner tube having the one or more ribbedfeatures formed on an external surface thereof. The second tube can bean outer tube having the one or more ribbed features formed on aninternal surface thereof, the outer tube having the inner tube slidablyengaged therein. The one or more ribbed features of the inner tube canbe complimentary to the one or more ribbed features of the outer tube,such that distal and proximal movement of the inner and outer tubesrelative to each other is prevented when the one or more ribbed featuresof the inner tube are engaged with the one or more ribbed features ofthe outer tube.

In some embodiments, a surgical access device can include a tubeincluding a plurality of tube segments connected by interlocking snapfeatures, the snap features including a protruding feature and adepression feature, wherein each of the plurality of tube segmentsincludes at least one of a protruding feature and a depression feature,wherein at least one of the plurality of tube segment includes aprotruding feature, and another of the plurality of tube segmentsadjacent to the one of the plurality of tube segments includes adepression feature, and wherein the one of the plurality of tubefeatures and the adjacent tube feature are attached to one another bythe protruding feature of the one tube segment being engaged with thedepression feature of the adjacent tube segment.

One tube segment can be detachable from the adjacent tube segment bydisengaging the protruding feature of the one tube segment from thedepression feature of the adjacent tube segment. The protruding featureof the one tube segment can be disengaged from the depression feature ofthe adjacent tube segment by applying a force to the protruding featurein a direction away from the depression feature.

In some embodiments, a surgical access device can include a tube havinga distal end and a proximal end, and corrugated features along a portionof a length of the tube, the corrugated features being configured to bepulled and pushed to extend and retract the length of the tube. Thecorrugated features can be provided adjacent to the proximal end of thetube.

In some embodiments, a surgical access device can include a first tubehaving a proximal end and a distal end, the first tube including fingersextending from the proximal end to the distal end; a second tube havinga proximal end and a distal end, the second tube including fingersextending from the distal end to the proximal end, wherein the fingersof the first tube and the fingers of the second tube being are spacedpart from each other, and wherein the fingers of the first tube areconfigured to engage with the fingers of the second tube to fix theposition of the first tube relative to the second tube.

The size, shape and position of the fingers of the first tube can beequal to the size, shape and position of the fingers of the second tube.The fingers of the first tube can distally and proximally slide betweenthe fingers of the second tube. The circumference of the first tube canbe equal to the circumference of the second tube.

BRIEF DESCRIPTION OF DRAWINGS

This disclosure will be more fully understood from the followingdetailed description taken in conjunction with the accompanyingdrawings, in which:

FIG. 1 is a side view of one exemplary embodiment of a surgical accessdevice, shown in a disassembled state;

FIG. 2A is a side view of the surgical access device of FIG. 1, shown inan assembled state;

FIG. 2B is a perspective view of the surgical access device of FIG. 1;

FIG. 2C is another perspective view of the surgical access device ofFIG. 1;

FIG. 3A is side view of the surgical access device of FIG. 1 in a lockedposition;

FIG. 3B is side view of the surgical access device of FIG. 1 in anunlocked position;

FIG. 3C is side view of the surgical access device of FIG. 1,schematically illustrating a length adjustment of the access device;

FIG. 3D is side view of the surgical access device of FIG. 1 in a lockedposition;

FIG. 4 is a sectional side view of another exemplary embodiment of asurgical access device;

FIG. 5 is a perspective view of another exemplary embodiment of asurgical access device;

FIG. 6A is a perspective view of an exemplary tube of another exemplaryembodiment of a surgical access device;

FIG. 6B is another perspective view the tube of FIG. 6A;

FIG. 6C is a top view of an exemplary embodiment of a ring of thesurgical access device of FIG. 6A;

FIG. 6D is a perspective view of the ring of FIG. 6C;

FIG. 6E is a another perspective view of the ring of FIG. 6C;

FIG. 7A is a perspective view of another exemplary embodiment of asurgical access device;

FIG. 7B is another perspective view of the surgical access device ofFIG. 7A;

FIG. 7C is a bottom view of the surgical access device of FIG. 7A;

FIG. 7D is another perspective view of the surgical access device ofFIG. 7A;

FIG. 8 is a perspective view of another exemplary embodiment of asurgical access device;

FIG. 9A is a side view of another exemplary embodiment of a surgicalaccess device;

FIG. 9B is a perspective view of the surgical access device of FIG. 9A;

FIG. 9C is another perspective view of the surgical access device ofFIG. 9A;

FIG. 9D is another perspective view of the surgical access device ofFIG. 9A;

FIG. 9E is an exploded perspective view of the surgical access device ofFIG. 9A;

FIG. 10A is a perspective view of another exemplary embodiment of anaccess device, shown inserted through a skin surface of a patient andsecured to a remote anchor point;

FIG. 10B is another perspective view of the access device of FIG. 10A;

FIG. 10C is another perspective view of the access device of FIG. 10A;

FIG. 11A is another perspective view of the access device of FIG. 10A ina placement state;

FIG. 11B is another perspective view of the access device of FIG. 11A ina support ring placement state;

FIG. 11C is another perspective view of the access device of FIG. 11A ina state of bending the bendable arms;

FIG. 11D is another perspective view of the access device of FIG. 11A ina state of attaching the bendable arms to the patient;

FIG. 11E is another perspective view of the access device of FIG. 11A ina state of attaching a bendable arm to a remote anchor point;

FIG. 12 is a sectional side view of another exemplary embodiment of asurgical access device;

FIG. 13A is a side view of another exemplary embodiment of a surgicalaccess device, in a snapped-in configuration;

FIG. 13B is another side view of the surgical access device of FIG. 13Ain an unsnapping configuration;

FIG. 13C is a sectional side view of a snap feature of the surgicalaccess device of FIG. 13A;

FIG. 14 is a side view of another exemplary embodiment of a surgicalaccess device;

FIG. 15A is a perspective view of another exemplary embodiment of asurgical access device;

FIG. 15B is a perspective view of an unattached tube of the surgicalaccess device of FIG. 15A; and

FIG. 16 is a perspective view of an exemplary connection feature of asurgical access device.

DETAILED DESCRIPTION

Adjustable-length surgical access devices are disclosed herein, whichcan advantageously allow an overall length of the access device to bequickly and easily changed by the user. The access devices herein canreduce or eliminate the need to maintain an inventory of many differentlength access devices. In some embodiments, the length of the accessdevice can be adjusted while the access device is inserted into thepatient. This can reduce or eliminate the need to swap in and outseveral different access devices before arriving at an optimal lengthaccess device. This can also reduce or eliminate the need to change theaccess device that is inserted into a patient as the depth at which asurgical step is performed changes over the course of a procedure.Rather, the length of the access device can be adjusted in situ andon-the-fly as needed or desired to accommodate different surgicaldepths.

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present disclosure. Further, to the extent features orsteps are described as being, for example, “first” or “second,” suchnumerical ordering is generally arbitrary, and thus such numbering canbe interchangeable.

The present disclosure includes some illustrations and descriptions thatinclude prototypes or bench models. A person skilled in the art willrecognize how to rely upon the present disclosure to integrate thetechniques, devices, and methods provided for into a product, such as aconsumer ready, warehouse-ready, or operating room ready surgicaldevice.

A person skilled in the art will appreciate that the present disclosurehas application in conventional endoscopic, minimally-invasive, and opensurgical procedures.

Exemplary embodiments of the present disclosure provide surgical accessdevices, and more specifically, adjustable-length surgical accessdevices. The surgical access device can include one or more tubes orportions that can be manipulated to obtain a surgical access device of adesired length that is optimal or desirable to access a patient'ssurgical site of interest. Examples of such manipulations can includepulling, pushing, twisting, rotating, pivoting, folding, sliding, and/orcombinations thereof. Engagement features provided on the surgicalaccess device, including, for example, on inner and outer surfacesthereof, can prevent, limit or restrict the lengthening and shorteningof the surgical access device in certain circumstances, such as when themanipulations described above are performed with minimal or incidentalforce, e.g., below an identified force threshold. Such features caninclude grooves, threads, slots, protrusions, depressions, lips, and thelike. Thus, the features can limit or prevent inadvertent lengtheningand shortening of the surgical access device once the surgical accessdevice has been configured to its desired length. The surgical accessdevice can be or can include an enclosed tubular structure, a slotted orbladed retractor, a cannula, and so forth.

The surgical access device can include a proximal end, proximate to auser of the surgical access device, and a distal end, proximate to thepatient or the patient's surgical region. Formed through the surgicalaccess device can be a hole or opening, extending from the proximal endto the distal end, defining a working channel through which implants,instruments, or other objects can be inserted to or removed from thepatient's body.

The surgical access device can include a body, which can refer to thestructure that makes up the external and internal surfaces of thesurgical access device. The internal surface of the body can define theworking channel through the surgical access device. The surgical accessdevice can be round, square, rectangular, or any other shape, as deemednecessary or desirable to access a patient's surgical region. Likewise,the working channel formed through the surgical access device can beround, square, rectangular or any other shape, as deemed necessary ordesirable to enable the insertion and removal of implants, instruments,or other objects for surgery.

The thickness of the body of the surgical access device, and other ofits dimensions (e.g., diameter, inner circumference, outercircumference) can vary, so long as the aspects described hereinenabling length adjustment are retained.

First Embodiment

FIGS. 1, 2A to 2C, and 3A to 3D illustrate one exemplary embodiment of asurgical access device 100 configured to provide operative access to apatient's anatomy. Although the surgical access device 100 may bedescribed with reference to its use to access a patient's intervertebraldisc during spinal surgery, it should be understood that the surgicalaccess device 100 can be configured and used in accordance with othersurgical procedures to access to other surgical regions within apatient.

As shown, the surgical access device 100 can include an upper tube 102,a middle tube 104, a lower tube 106, and a spring 108. FIG. 1illustrates the disassembled parts or components of the access device100, namely the upper tube 102, middle tube 104, lower tube 106, andspring 108. In some embodiments, the access device 100 is referred to asa “telescoping tube,” due to its being configured so that the upper,middle and lower tubes 102, 104, and 106 fit within one another in a waythat allows them to slidably engage to enable the length of the accesstube 100 to be extended and retracted.

The upper tube 102, middle tube 104, and lower tube 106 can be referredto as a first inner tube, outer tube, and second inner tube,respectively, to describe their inner and outer positions in theassembled surgical access device 100.

Still with reference to the disassembled access device 100 shown in FIG.1, the upper tube 102, the middle tube 104, the lower tube 106, and thespring 108 can each include at least a portion that is substantiallytubular or cylindrical. The upper tube 102, the middle tube 104, thelower tube 106, and the spring 108 can be assembled into alength-adjustable surgical access device 100 that can be used to accessthe patient's anatomy during surgery. To assemble the surgical accessdevice 100, the distal end 102 d of the upper tube 102 can be insertedthrough the spring 108. The distal end 102 d of the upper tube 102, onceinserted through the spring 108, can be inserted into the proximal end104 p of the middle tube 104. The proximal end 106 p of the lower tube106 can be inserted into or within the distal end 102 d of the uppertube 102. In use, the middle tube 104 can be axially translated in aproximal direction relative to the upper tube 102, against the bias ofthe spring 108. With the middle tube 104 translated proximally, one ormore resilient fingers 102 f formed at the distal end of the upper tube102 can expand radially-outward to disengage from the lower tube 106,thereby allowing the lower tube 106 to translate axially relative to theupper tube 102 to set an overall length of the access device 100. Whenset to the desired length, the middle tube 104 can be released, suchthat it returns distally under the bias of the spring 108. As the middletube 104 moves distally, it can urge the fingers 102 f radially-inwardinto engagement with the lower tube 106 to fix the length of the accessdevice 100.

The upper tube 102 can include a proximal end 102 p. The proximal end102 p can include or can have formed thereon a stop 102 s configured toabut the proximal end 104 p of the middle tube 104, to stop or preventthe middle tube 104 from excessive proximal movement relative to theupper tube 102. The stop 102 s can extend radially about the proximalend 102 p of the upper tube 102. In other words, to prevent excessiveproximal movement of the middle tube 104, the outer surface of the stop102 s can have a circumference that is larger than (1) the circumferenceof the outer surface of the adjacent proximal end 102 p of the uppertube 102, and (2) the circumference of the inner surface of the proximalend 104 p of the middle tube 104. The outer surface of the stop 102 scan be textured with grooves and/or ridges to enhance its grippingqualities, thereby allowing the access device 100 to be more easilymanipulated by a user, for example, to stabilize or twist the accessdevice 100.

The stop 102 s can include a connector interface 102 c which can allowthe position and/or orientation of the access device 100 to be fixed viaa connector or other support (not illustrated). The connector interface102 c can be built in to or can protrude outwardly from the stop 102 s.A connector can be used to connect the connector interface 102 c of theaccess device 100 to an ipsilateral or contralateral pedicle anchor oranatomical support, operating table, or other support or stabilizingfeature (not illustrated). The connector interface 102 c can be used asa stabilizer portion during actuation of the access device 100.

The stop 102 s and/or the connector interface 102 c can be formedintegrally with the upper tube 102 p, or can be manufactured as aseparate component that is attachable to the upper tube 102 p.

The upper tube 102 can include a distal end 102 d. The distal end 102 dcan have formed thereon flexible fingers 102 f 1 and 102 f 2(collectively “102 f”) configured to engage with the lower tube 106 andlimit or prevent the distal or proximal movement of the lower tube 106relative to the upper tube 102. The flexible fingers 102 f can be formedby slits (or cuts) formed in the body of the upper tube 102, startingfrom the distal end 102 d toward the proximal end 102 p. The proximalend of the slits can include a circle or hole of larger diameter thanthe slits, to enable the fingers to more easily, and/or more widely,expand or deflect as explained below. The flexible fingers 102 f caninclude any number of fingers and can be created by one or more slits.

The length of the slits on the body of the upper tube 102 can be thesame or can vary. The length of the slits forming the fingers 102 f canbe determined based on the length of the middle tube 104 and/or thelower tube 106, on the amount of engagement that is desired between theupper tube 102 and the lower tube 106, and/or on the amount ofdeflection or expansion of the fingers 102 f that is desired or to beallowed. The length of the slits forming the fingers 102 f can be equalto or greater than the difference in length between the upper tube 102and the middle tube 104. The length of the slits forming the fingers 102f can be equal to or greater than the length of the outer surface of theupper tube 102 at the distal end 102 d that is exposed when the middletube 104 is fully retracted. The length of the slits can be in the rangeof 1% to 33% of the length of the upper tube 102 (e.g., 1%, 5%, 10%,15%, 20%, 25%, 30%, 33%).

The inner surface of the upper tube 102 can include grooves or ridgesthat are congruent with, complementary to, or that mate with counterpartgrooves or ridges on the outer surface of the lower tube 106. The ridgesor grooves can be spiral, circular or otherwise shaped to engage withcounterpart features to limit or prevent movement of the upper and lowertubes 102 and 106, relative to one another, in a lengthwise, proximaland distal direction. The grooves or ridges on the inner surface of theupper tube 102 can be formed on the distal end 102 d, e.g., on thefingers 102 f. The grooves and/or ridges can be referred to ascomplementary engagement features.

As explained in further detail below with reference to FIGS. 3A to 3D,the fingers 102 f can be actuated (e.g., expand, deflect, flare) byproximally retracting the middle tube 104 relative to the upper tube102, allowing the fingers 102 f to expand or flare outward in thedirection A illustrated in FIGS. 3B and 3C, thereby increasing orenlarging the diameter of the opening of the upper tube 102 at thedistal end 102 d where the fingers 102 f are formed. When the fingersare in an expanded state (e.g., flared), as opposed to their default orrest state (e.g., contracted), the increased diameter of the distal end102 d can allow the lower tube 106 to slide or be moved distally andproximally relative to the upper tube 102. A desired total length of theaccess device 100 can be set by releasing the middle tube 104 from itsretracted position, causing the middle tube 104 to move distallyrelative to the upper tube 102 as a result of the bias of the spring108, and causing the fingers 102 f to retract (e.g., opposite ofdirection A) and the diameter of the opening of the distal end 102 d todecrease.

As mentioned above and described in further detail below, when thefingers 102 f are flexed inward from their default position, the grooveson the inner surface of the upper tube 102 can engage with grooves inthe outer surface of the lower tube 106. The lower tube 106 can includea distal end 106 d and a proximal end 106 p. The diameter of the openingof the tube 106 formed by the inner surface can be the same at thedistal end 106 d and at the proximal end 106 p. The external surface ofthe lower tube 106 can include or have formed thereon grooves (orridges) that are configured to engage with matching, mating, orcomplementary grooves on the internal surface of the upper tube 102. Thegrooves on the lower tube 106 can be provided at various regions alongthe length of the tube, as needed to achieve the desired length andstability characteristics of the access device 100 for its use insurgery.

The outer surface of the lower tube 106 can have markings, writingand/or other indications thereon. Markings provided along the length ofthe outer surface of the lower tube 106 can indicate lengths or othermeasurements (e.g., of the access device 100, of the lower tube 106,etc.) when the upper tube 102 is fixedly engaged with the lower tube106. For example, the length of the access device 100 can be themeasurement marked on the external surface of the lower tube 106 at theposition where the distal end 102 d of the upper tube 102 extends to.

As mentioned above and described in further detail below, to fix theposition of the lower tube 106 relative to the upper tube 102 along adistal and proximal direction, and/or to fix the length of the accessdevice 100, the middle tube 104 can be operated by proximal retractionand distal extension movements. The middle tube 104 can include aproximal end 104 p and a distal end 104 d.

The proximal end 104 p of the middle tube 104 can include or can haveformed thereon wings 104 w (or rings, handles, ears, or another similarstructure) that allow a user of the access device 100 to retract, pullor otherwise move or slide the middle tube 104 toward the proximal end102 p of the upper tube 102. The wings 104 w can protrude or can beformed away from the external surface of the middle tube 104. The wings104 w or a portion thereof can extend away from the external surface ofthe middle tube 104 such that the wings 104 w form a right angle or anoblique angle with the outer surface of the middle tube 104. The wings104 w can form a curve away from the external surface of the middle tube104, such that the distal-most end of the wings 104 w are formed awayfrom the distal end 104 d of the middle tube 104.

The dimensions, shape and other attributes of the wings 104 w can varyas needed to provide an area where the user's fingers (e.g., middle andpointer fingers) can engage and pull the middle tube 104 toward theproximal end 102 p of the upper tube 102. For instance, the curvatureand length of the wings 104 w can be determined and/or configuredaccording to the average or maximum size of a human's index and/ormiddle fingers. Likewise, other configurations of the wings 104 w, suchas rings, can be rings that are formed external to or protruding fromthe outer surface of the middle tube 104 and that have an opening with acircumference larger than the average or maximum size of a human's indexand/or middle fingers. It should be understood that the access device100 can include one or more wings 104 w.

As described in further detail below, when the middle tube 104 isretracted or pulled toward the proximal end 102 p of the upper tube 102,the spring 108 that is disposed between the middle tube 104 and theupper tube 102 can be compressed. The size (compressed and uncompressed)and amount of force needed to compress the spring 108 can be determinedbased on various factors including the typical user's preference, theamount of time and speed at which the spring decompresses from thecompressed state, the length of the tubes 102, 104, and 106, thematerial of the spring 108, and/or the thickness of the spring 108. Thelength of the spring 108 or the amount of lengthwise space that theuncompressed spring 108 covers when engaged with the upper tube 102 canbe less than or equal to the difference in the length of the upper tube102 and the middle tube 104. The spring 108 can be configured such thatthe amount of force needed to compress the spring 108 is (1) high enoughso that the spring 108 returns towards a resting state to drive themiddle tube 104 distally relative to the proximal end 102 p of the uppertube 102 and maintain the set length of the access device 100; and (2)low enough so that the driving of the middle tube 104 distally relativeto the proximal end 102 p of the upper tube 102 is slow and controlledenough to not significantly alter the position of the access device 100(e.g., relative to a patient) or the position of the tubes 102, 104, and106 relative to one another.

As described above, the access device 100 can provide access to apatient's anatomy during surgery. Accordingly, the length of the accessdevice 100 at its longest configuration can be large enough to reach ananatomical point of interest. To this end, each of the tubes 102, 104,and 106 can have a respective length such that, when the tubes 102, 104,and 106 are assembled together with the spring 108 to form the accessdevice 100, the desired total length of the access device 100 can beachieved. The length of the upper tube 102 can be greater than thelength of the middle tube 104 and the lower tube 106. The length of themiddle tube 104 can be less than the length of the upper tube 102 andthe lower tube 106. The length of the lower tube 106 can be greater thanthe length of the middle tube 104, and less than, equal to or greaterthan the length of the upper tube 102. The length of the lower tube 106and/or the length of the grooved portion of the outer surface of thelower tube 106 can be equal to or greater than the distance from apatient's skin (e.g., where an incision is made and the access device100 inserted) to the part or area of the patient's anatomy to whichaccess is required, such that when the lower tube 106 is the only one ofthe tubes 102, 104, and 106 that is inserted into the incision, thelower tube 106 can reach and access that part or area of the patient'sanatomy.

The openings or working channel created by the inner surfaces of thetubes 102, 104, and 106 can be large enough to enable objects (e.g.,implants, instruments, or other objects) to be moved therethrough, toand from the distal end 100 d and the proximal end 100 p of the accessdevice 100. The diameter and/or circumference of the opening of each ofthe tubes 102, 104, and/or 106 can vary from their distal ends to theirproximal ends For example, the upper tube 102 can be configured suchthat the diameter or circumference of the opening at the proximal end102 p is larger than the diameter or circumference, respectively, of theopening at the distal end 102 d. The openings of the tubes 102, 104,and/or 106 can gradually narrow or expand along their lengths.

The circumference of the opening of the middle tube 104 (at the proximalend 104 p and the distal end 104 d) can be larger than the circumferenceof the outer surface of the upper tube 102 (at the distal end 102 d andthe proximal end 102 p), such that the distal end 102 d of the uppertube 102 can be inserted through the opening at the proximal end 104 pof the middle tube 104 and through the entirety of the length of themiddle tube 104, exiting at the distal end 104 d. The circumference ofthe opening of the middle tube 104 can be larger than the circumferenceof the outer surface of the lower tube 106. The circumference of theopening of the upper tube 102 at the distal end 102 d and/or along thelength of the fingers 102 f, when the fingers 102 f are in aradially-inward position, can be equal to or smaller than thecircumference of the outer surface of the lower tube 106; and thecircumference of the opening of the upper tube 102 at the distal end 102d and/or along at least a portion of the length of the fingers 102 f,when the fingers 102 f are at an expanded or radially-outward position,can be larger than the circumference of the outer surface of the lowertube 106. The circumference of the opening of the spring 108 can belarger than the circumference of the outer surface of the upper tube102.

As described above, the tubes 102, 104, and 106, and the spring 108 canbe assembled to form the access device 100. FIGS. 3A to 3D illustrate aprocess for using and/or adjusting the length of the access device 100according to an exemplary embodiment. As will be described, the accessdevice 100 can be actuated by (1) retracting the middle tube 104relative to the upper tube 102, similar to a syringe; (2) adjusting theexposed length of the lower tube 106; and (3) releasing the middle tube104.

More specifically, FIG. 3A illustrates the access device 100 in adefault or locked state in which the length of the access device isfixed. When the access device 100 is in its default state, the spring108 (not shown in FIG. 3A) can urge the middle tube 104 distallyrelative to the upper tube 102. That is, the proximal end 104 p of themiddle tube 104 can be forced to its furthest position from the proximalend 102 p of the upper tube 102 by the bias of the spring 108. In thisposition, the internal surface of the middle tube 104 can maintain thefingers 102 f of the upper tube 102 in a radially-inward position inwhich they engage with the grooves or other engagement features of thelower tube 106. In such a position of the middle tube 104, a small part(e.g., 1%, 2%, 5%, 10%, 15%) of the fingers 102 f can be exposed so longas the fingers 102 f are not free to expand out of engagement with thelower tube 106.

The access device 100 can be actuated by pulling, retracting orotherwise proximally moving or sliding, relative to the upper tube 102,in the direction B, the middle tube 104 toward the proximal end 102 p ofthe upper tube 102, as shown in FIG. 3B. The actuation of the accessdevice 100 can be performed by applying a pushing pressure or force onthe proximal end 102 p (or stop 102 s) of the upper tube 102 (e.g., by auser's thumb), and applying an opposite pulling pressure or force on thewings 104 w of the middle tube 104 (e.g., by the user's index and middlefinger), against the bias of the spring 108.

When the middle tube 104 is in the retracted position, as shown in FIGS.3B and 3C, the distal end 104 d of the middle tube 104 is moved towardthe proximal end 102 p of the upper tube 102. Because the upper tube 102is longer than the middle tube 104, such a proximal retraction of themiddle tube 104 can cause the fingers 102 f of the upper tube 102 tobecome exposed. When the fingers 102 f are exposed and no longercompressed by the inner surface of the middle tube 104, the fingers 102f can be free to expand in the direction A. The flaring or expanding ofthe fingers 102 f can cause the diameter of the opening at the distalend of the upper tube 102 and/or the circumference of the inner surfaceof the upper tube at the fingers 102 f to increase in size (e.g., to asize larger than the diameter or circumference of the lower tube 106).This can cause the fingers 102 f and the lower tube 106 to no longer beengaged or fixedly positioned, thereby allowing the lower tube 106 to beslid or translated proximally or distally relative to the distal end 102d of the upper tube 102, as shown in FIG. 3C.

The lower tube 106 can continue to be moved proximally and distally solong as the access device 100 is actuated (e.g., the middle tube 104remains in the retracted position). When the lower tube 106 is moved toits desired location such that the access device 100 has a resultingoptimal or desired length for surgical use, the proximal or pullingforce on the middle tube 104 and/or the distal or pushing force on theupper tube 102 can be released, causing the upper tube 102 and themiddle tube 104 to return towards their default positions, and thefingers 102 f to be compressed by the internal surface of the middletube 104, such that the position of the lower tube 106 relative to theupper tube 102 becomes fixed. In other words, as shown in FIG. 3D, whenthe force on the upper tube 102 and/or the middle tube 104 is released,the spring 108 can expand, causing the middle tube 104 to move distally,away from the proximal end 102 p of the upper tube 102. In addition, thepreviously exposed fingers 102 f can become unexposed by sliding withinthe inner surface of the distal end 104 d of the middle tube 104. As aresult, the fingers 102 f can compress, causing the ridges or grooves onthe inner surface of the fingers 102 f to engage with the ridges orgrooves on the outer surface of the lower tube 106, thereby locking orpreventing the distal or proximal movement of the lower tube 106relative to the upper tube 102. The resulting access device 100 can havea length that is determined based on the selected amount of exposed areaof the lower tube 106, as set by the position where the lower tube 106is locked. The access device 100 can then be used to access a target ordesired area of the patient's anatomy located at a distance that isreachable by the access device 100 having been set at a desired length.

Second Embodiment

FIG. 4 illustrates another exemplary embodiment of a surgical accessdevice 200. The surgical access device 200 can include an inner tube 202and an outer tube 204. The inner tube and the outer tube can haverespective proximal ends (202 p, 204 p) and distal ends (202 d, 204 d),and holes or openings formed therethrough from their distal ends to theproximal ends to define a working channel through the access device.

The inner tube 202 can be slidably disposed within the outer tube204—e.g., within the opening of the outer tube 204 to define atelescoping access device. The inner tube 202 and the outer tube 204 canbe configured such that sufficient friction is created between theexternal surface of the inner tube 202 and the internal surface of theouter tube 204 to maintain a relative longitudinal position of the innerand outer tubes. To accomplish the desired friction between the tubes202 and 204, the inner tube 202 can have an external surface with acircumference equal to or substantially equal to the circumference ofthe opening or internal surface of the outer tube 204.

To adjust the length of the surgical access device 200, opposite pullingand pushing forces can be applied to the tubes 202 and 204 to overcomethe frictional force and axially translate the tubes relative to oneanother to shorten or lengthen the access device. When the pulling andpushing force is ceased, the friction between the tubes 202 and 204 canbe effective to restrict the proximal and distal movement of the tubes202 and 204 and to maintain the device 200 at the adjusted length. Theinner and outer tubes 202, 204 can be rotationally fixed relative to oneanother, e.g., such that they inner and outer tubes cannot rotated withrespect to one another about a central longitudinal axis of the device200. The tubes 202, 204 can be rotationally fixed in various ways, suchas by engagement between counterpart longitudinal rails and grooves, apin-in-slot arrangement, or the like.

Third Embodiment

FIG. 5 illustrates another exemplary embodiment of a surgical accessdevice 300 configured to provide operative access to a patient'sanatomy. The surgical access device 300 can include a tube or bodyhaving an opening or working channel formed therethrough from a distalend 300 d to a proximal end 300 p. The working channel can be defined byan inner surface of the surgical access device 300. The working channelcan be round, square, rectangular, and/or various other shapes, and canhave a diameter or circumference of any size, so long as objects (e.g.,implants, instruments, or other objects) can be moved to and from theproximal end 300 p and the distal end 300 d. The shape, diameter, and/orcircumference of the working channel can change between the distal end300 d and the proximal end 300 p. In other words, for example, theopening at the distal end 300 d can be smaller or narrower than theopening at the proximal end 300 p of the surgical access device 300. Itshould be understood that the shape of the access device 300, which isdefined by its external surface, can match the shape of the opening(e.g., circle, rectangle, square), or can have a shape that is differentthan that of the opening.

The surgical access device 300 can be manufactured at a single maximumlength determined to reach the deepest area of interest of a patient'sbody to be accessed during surgery. However, to enable the surgicalaccess device 300 to be used at various lengths as needed to optimallyor desirable access shallower regions in a patient's body, the accessdevice 300 can include one or more slits or perforations 308 around atleast part of the circumference of the external surface of the accessdevice 300, which facilitate the breaking (e.g., splitting, tearing,separating) of the access device 300 into multiple parts. Theperforations 308 can have regions (e.g., circular perforations) that arelarger in diameter than the rest of the slits of the perforations, toprovide for easier breaking thereat. Breaking the access device 300 intomultiple parts can be achieved in various ways, such as by twisting theaccess device 300 at opposite sides of the selected perforation 308, orbending, folding or applying force to the access device at oppositesides of the selected perforation 308, e.g., about a fixed pivot pointequal to the position of the selected perforation 308 on the accessdevice 300.

As shown in FIG. 5, the access device 300 can include a plurality ofperforations 308 a and 308 b formed around part of the circumference ofthe access device at various positions along the length of the accessdevice 300. Although only two perforations (308 a and 308 b) areillustrated in FIG. 5, any number of perforations can be provided on theaccess device 300. The perforations can be provided at regular orirregular intervals along the length of the access device 300. Theperforations can be provided starting at the distal end or at theproximal end of the access device 300.

The perforations 308 can be provided around less than the entirecircumference of the access device 300 (e.g., 10%, 25%, 33%, 50%, 75%).The perforations can be provided around a part of the circumference ofthe access device 300 that sufficient to allow for manual breakage ofthe access device 300 into multiple parts, preferably without anymachine or tool assistance.

The length, depth, and width of the perforations 308 can vary betweenindividual perforations on the access device 300, or between differentaccess devices, as deemed necessary or desirable to enable manualbreakage. For instance, the length, depth, and width of the perforations308 can be based on the properties of the material used to manufacturethe access device 300, the thickness of the body of the access device300, the circumference of the access device 300, or other parameters.

The perforations 308 can have a length or other measurement associatedtherewith and marked on the external surface of the access device 300.These markings can allow a user to identify the resulting length of theaccess device 300 when the access device is broken at the respectiveperforation 308. The access device 300 can be configured such that, whenit is broken into multiple parts, either the distal end or the proximalend of the original full-length access device 300 can be the resultingaccess device 300 to be used to access a part of a patient's body.

The access device 300 can be provided without perforations, such thatthe access device 300 is instead cut at a desired region or length usinga machine or tool. The access device 300 can include lines or markingsindicating different measurements or lengths at which the access devicecan be cut using a machine or tool, thereby enabling identification ofthe resulting length of the access device 300 after it is cut intomultiple parts.

Fourth Embodiment

FIGS. 6A to 6E illustrate another exemplary embodiment of a surgicalaccess device 400. As illustrated, the access device 400 can include amain body or tube 402 and a ring portion 404. The main body 402 can becut, torn, or broken to the desired length, and the ring portion 404 canbe attached thereto, e.g., to provide an anchoring point for stabilizingthe main body or to cover the broken end of the main body. The tube 402can be the access device 300 described above, for example, after havingbeen split or cut into multiple parts to obtain a tube of a resultingoptimal or desirable size for accessing a patient's target area.

As shown in FIGS. 6A to 6E, the tube 402 can include an opening orworking channel formed therethrough, from a proximal end 402 p to thedistal end 402 d. The shape and size of the opening, defined by theinner surfaces of the tube 402, can vary, as described herein. The shapeand size of the opening can vary throughout the length of the tube 402.For example, the size of the opening can narrow from the proximal end402 p to the distal end 402 d. The shape and size of the access device400, as defined by its external surfaces, can also vary as describedherein.

The ring portion 404 of the access device 400 can be attached or mountedonto the proximal end 402 p of the tube 402. The proximal end 402 p ofthe tube 402 can be the cut end of a tube after being cut or divided asdescribed above in connection with FIG. 5. The ring 404, when attachedto the tube 402, can provide enhanced handling and stabilizing of theaccess device 400 as explained in further detail below. The ring 404 caninclude a proximal side 404 p and a distal side 404 d. The ring 404 caninclude one or more concentric walls, e.g., an exterior wall 404 e, aninterior wall 404 i, and a middle wall 404 m as shown. The exterior,interior and middle walls 404 e, 404 i, and 404 m can extend distallyfrom the proximal end 404 p, lengthwise, to a length deemed sufficientto stabilize the tube 402 and the ring 404 when they are engaged. Thelength of the walls 404 e, 404 i and/or 404 m can be based on the lengthof the tube 402. That is, the walls 404 e, 404 i and 404 m can have alength proportional to the length of the tube 402. The length of thewalls 404 e, 404 i, and 404 m can vary in size between each other.

The proximal side 404 p of the ring 404 can be covered or sealed betweenthe external wall 404 e and the internal wall 404, such that the spacesbetween the walls 404 e, 404 i and 404 m cannot be accessed from aproximal-to-distal direction. The part of the proximal side 404 p thatis internal or within the internal wall 404 i can be open, such that anopening is created through the proximal end 404 p to the distal end 404d of the ring 404. The distal side 404 d of the ring 404 can be exposed,allowing the spaces between the walls 404 e, 404 i, and 404 m to beaccessed or entered from a distal-to-proximal direction, for example, tomount the ring 404 onto the tube 402 as explained in further detailbelow.

The interior wall 404 i can have a smaller circumference than the middlewall 404 m and the exterior wall 404 e. The middle wall 404 m can have acircumference smaller than that of the exterior wall 404 e and largerthan that of the interior wall 404 i. The difference in size between thecircumference of the middle wall 404 m and the interior wall 404 i—i.e.,the gap therebetween—can be configured based on the thickness of thetube 402 at its proximal end.

The middle wall 404 m can be a fully-closed circle. In otherembodiments, such as that shown in FIGS. 6A to 6E, the middle wall 404 mcan be made up of or can include intermittent or spaced apart wallportions (e.g., 404 m-1, 404 m-2, etc.) that extend distally from theunderside of the ring 404, and that form the wall 404 m. The wallportions can be referred to as “fingers” that extend distally from thedistal-facing side of the proximal end 404 p of the ring 404. The wallportions of the wall 404 m can be flexible and/or resilient such thattheir distal ends can move radially-inward or radially-outward. Forexample, the wall portions can flex or deflect away from the interiorwall 404 i and toward the external wall 404 e when pressure is appliedthereto as a tube 402 is inserted into the space between the middle wall404 m and the internal wall 404 i. Such flexibility of the wall portionscan enable insertion of a tube 402 having a thickness equal to or largerthan the space between the middle wall 404 m and the interior wall 404i, when the wall portions are not deflected from their resting position,to be inserted therebetween.

An internal surface of the middle wall 404 m (e.g., the surface of themiddle wall 404 m facing the internal wall 404 i), and or an outersurface of the internal wall can include one or more slits, teeth, orother surface features for engaging the tube 402. The surface featurescan be directional, e.g., unidirectional, such that the surface featuresallow insertion of the tube 402 in a proximal direction but resist orprevent removal of the tube 402 in a distal direction. For example, thesurface features can include teeth that are angled facing toward theproximal side 404 p of the ring 404. In this way, when the tube 402 isinserted from the distal side 404 d of the ring 404 toward its proximalside 404 p, along the space between the middle wall 404 m and theinternal wall 404 i, the distal-most ends of the teeth of the middlewall 404 can contact and slide along the external surface of theproximal end 402 p of the tube 402. In turn, pulling the tube 402 in adistal direction away from the ring 404 can cause the teeth of the wall404 m to penetrate the body of the tube 402, thereby creating orincreasing a grip of the ring 404 on the tube 402.

The space between the middle wall 404 m and the internal wall 404 i canbe measured from the distal end of the teeth of the middle wall 404 m tothe external surface of the internal wall 404 i. In some embodiments,the ring 404 can include only an external wall 404 e and an internalwall 404 i, without a middle wall 404 m. In such embodiments, the teethof the middle wall 404 m described above can be provided in the internalsurface of the external wall 404 e, and the space between the externalwall 404 e and the internal wall 404 i can be configured similar to thespace between the middle wall 404 m and the internal wall 404 idescribed above, to receive the proximal end 402 p of the tube 402.

With the ring 404 mounted on the tube 402, the access device 400 can bemore easily gripped by virtue of the larger size of the ring 404compared to the tube 402. Moreover, the access device 400 can bestabilized using a stabilization feature 405 provided on the ring 404.The stabilization feature 405 can be a structure extending away from theexternal-facing side of the external wall 404 e, and can be shaped invarious ways. The stabilization feature 405 can be used to connect orattach the access device 400 to an ipsilateral or contralateral pedicleanchor or anatomical support, to a connector, operating table, or othersupport feature, which can provide stabilization of the access device.As shown in FIG. 6, the stabilization feature 405 can be shaped like aball, e.g., in order to connect with a support via a ball and socketjoint configuration.

Fifth Embodiment

FIGS. 7A to 7D illustrate another exemplary embodiment of a surgicalaccess device 500. The surgical access device 500 can include an innertube 502 and an outer tube 504. The inner tube 502 and the outer tube504 can include openings or working channels formed to and from theirrespective proximal and distal ends. The openings of the inner and outertubes 502 and 504, defined by their respective inner surfaces, can varyin size and shape, as described above. The size and shape of the innerand outer tubes 502 and 504, as defined by their external surfaces, canlikewise vary in size and shape, as described above. The inner and outertube 502 and 504 can have similar shapes, and can be sized such that theinternal surface of the outer tube 504 has a circumference slightlylarger than the circumference of the external surface of the inner tube502, such that the inner tube 502 can slide within the opening of theouter tube 504 without allowing any or a substantial amount of movementof the inner tube 502 other than along distal and proximal directions.

As shown in FIGS. 7A to 7D, the access device 500 can includes aturn-advance-turn-lock mechanism having a plurality of slots 506-1,506-2, etc. (collectively “506”) formed on the outer tube 504 and a knob508 or a similar protrusion formed on the inner tube 502. In otherarrangements, the slots 506 can be formed in the inner tube 502 and theknob 508 can be formed on the outer tube 504. The knob 508 can be afeature protruding from an external surface of the inner tube 502. Theknob 508 can have a shape and size that matches the shape and size ofthe slots 506, such that the knob 508 can be slid into one of the slots506 to prevent or resist relative distal and proximal movement betweenthe inner and outer tubes. The thickness of the knob (e.g., the distancewhich the knob protrudes from the external surface of the inner tube502) can be at least equal to the thickness of the body of the outertube 504, as measured from its external surface to its internal surface.While the knob 508 can be provided in any position on the tube, in someembodiments, the knob 508 can be provided on or proximate to the distalend of the inner tube 502, enabling the length of the access device 500to be maximized.

The access device 500 can include a handle 512 for controlling thesliding and rotation of the inner tube 502 in the manner described infurther detail below, and/or for securing the access device 500 to asupport in the manner described herein.

The slots 506 of the access device 500 can be formed as holes orperforations through the external and internal surfaces of the outertube 504. The slots 506 can be formed at regular or irregular intervalsalong the length of the outer tube 504. The slots 506 can be disposed inthe same line as the proximal and distal length of the outer tube 504.The slots 506 can be connected by a path 507, which can enable movementof the knob 508 between the slots 506. Although eight slots 506 areshown in FIGS. 7A to 7D, the outer tube 504 can include any number ofslots. The path 507 can be an elongate slot having a longitudinal axisthat is parallel or substantially parallel to the longitudinal axis ofthe access device 500. The slots 506 can be defined as lateral orcircumferential extensions of the path 507, and can extend perpendicularto or obliquely from the path 507.

The outer tube 504 can include a sub-tube 510, which can be a tube thatis formed on the external surface of the outer tube 504. The sub-tube510 can be of a smaller size (e.g., length, circumference, and/or otherdimensions) and/or shape as the outer tube 504. The size and shape ofthe sub-tube 510 can change from its distal end 510 d to its proximalend 510 p. An opening or working channel can be formed through thesub-tube 510, to and from its proximal and distal ends 510 p and 510 d.The opening can be configured to provide supplemental access to thepatient's surgical area. For instance, the supplemental access providedby the opening can be used to insert an object or tool different thanthe object or tool inserted through the opening of the outer tube 504.Such separation of openings can be used when it is optimal to maintainthe tools or objects separate from one another during surgery. In someembodiments, a camera system can be inserted through the sub-tube 510.

To slidably engage the inner and outer tubes 502 and 504, the inner tube502 can be inserted into the outer tube 504. The inner and outer tubes502 and 504 can be manufactured or produced such that the inner tube 502is pre-inserted into the outer tube 504. To adjust the access device 500to a desired length, the inner and outer tubes 502 and 504 can be movedor positioned relative to each other, and the desired length locked orfixed by inserting the knob 508 into one of the slots 506.

More specifically, to set the length of the access device 500, the innertube 502 can be rotated about its central longitudinal axis relative tothe outer tube 504 (in a clockwise direction C when viewed from aproximal vantage point) until the knob 508 is positioned on the path 507and/or adjacent to the edge of the path 507 that is opposite the slots506. With the knob 508 positioned on the path 507, the inner tube 502can be moved distally or proximally, relative to the outer tube 504,along illustrated directions D and P. When the inner and outer tubes 502and 504 are positioned such that the access device 500 is of a desiredlength, the inner tube 502 can be rotated about its central longitudinalaxis relative to the outer tube 504 (in a counterclockwise direction C′when viewed from a proximal vantage point). Rotation of the inner tube502 in a counterclockwise direction can cause the knob 508 of the innertube 502 to slide from the path 507 into an adjacent one of the slots506. If a desired length of the access device 500 results in the knob508 being adjacent to a wall separating two of the slots 506, the innertube 506 can be further moved distally or proximally to slide the knob508 into one of the those two slots 506 (e.g., the slot closest to theknob 508). The inner tube 502 can be moved and rotated along directionsC, C′, P, and D using the handle 512.

With the knob 508 positioned in one of the slots 506, the distal end ofthe access device 500 can be inserted into a patient's body to reach adesired surgical region, without causing the length of the access device500 to be modified. That is, the shape of the slots 506 can prevent thedistal, proximal, and counterclockwise movement of the inner tube 502and/or its knob 508 relative to the outer tube 504. Prior to or whilethe access device 500 is inserted in the patient's body, the length ofthe access device 500 can be adjusted in the same fashion, by rotating(e.g., clockwise) the inner tube 502, sliding it proximally or distallyto achieve a desired length, and rotating the inner tube in the oppositedirection (e.g., counterclockwise) to lock its position in another oneof the slots 506. The illustrated access device 500 is configured suchthat the outer tube 504 is generally distal to the inner tube 502. Inother arrangements, the inner tube 502 can be generally distal to theouter tube 504.

Sixth Embodiment

FIG. 8 illustrates another exemplary embodiment of a surgical accessdevice 600. The surgical access device 600 can include an inner tube 602and an outer tube 604 that are telescopically mated to one another andthat define a working channel therethrough. The inner and outer tubes602, 604 can include engagement features configured to maintain arelative longitudinal position of the inner and outer tubes. Theengagements features can be threads that allow an overall length of theaccess device 600 to be adjusted by threading the inner tube 602 into orout of the outer tube 604. The engagement features can be configured toslip or skip when sufficient force is applied thereto. Accordingly,gross length adjustment can be achieved by simply pushing or pulling theinner and outer tubes with sufficient force to overcome the engagementfeatures. Fine length adjustment can be achieved by threading the tubesinto or out of one another.

An external surface of the inner tube 602 and an internal surface of theouter tube 604 can include complementary threads or similar engagementfeatures. The threads can spiral around all or a part of thecircumference of the external surface of the inner tube 602 and theinternal surface of the outer tube 604. For example, the threads can beformed as an interrupted spiral thread, as shown, having a plurality ofgaps between thread segments. The threads can be complementary to eachother, such that a male or external thread on one of the tubes 602 or604 engages with a female or internal thread on the other of the tubes602 or 604. The threads can be provided on any amount of length on thetubes 602 and 604.

The length of the surgical access device 600 can be adjusted in one ormore ways. For example, one way to adjust the length of the surgicalaccess device 600 can be by pulling or pushing, in opposite proximal anddistal directions, the inner tube 602 and the outer tube 604, withsufficient force to cause the thread of one of the tubes 602 or 604 toskip or slip over the thread of the other of the tubes 602 or 604. Thepulling or pushing can be repeated in order to skip or slip as manythreads as needed to place the inner and outer tubes 602 and 604 in aposition relative to one another that results in the desired length ofthe access device 600. One or both tubes 602, 604, or the engagementfeatures thereof, can be formed from a flexible or deformable materialto facilitate such slipping. The dimensions or material properties ofthe tubes 602 and 604, or the engagement features thereof, can beselected to ensure that threads are not slipped or skipped when minimalor incidental force or pressure is applied on the tubes 602 and 604.

Another way to adjust the length of the surgical device can be to rotatethe inner tube 602 clockwise or counterclockwise relative to the outertube 604, e.g., about a central longitudinal axis of the access device600. Rotating the inner tube 602 relative to the outer tube 604 cancause the threads of the inner and outer tubes 602 and 604 to advanceinto or out from one another to adjust an overall length of the accessdevice 600. This manner of adjusting the length of the access device 600can be more controlled and/or can allow for more precise smallincremental length adjustment as compared with the above describedthread skipping or sliding. The tubes 602 and 604 can be mated in aslight interference fit to resist or prevent relative rotation of theinner and outer tubes 602 and 604 when minimal or incidental rotationalforce is applied thereto.

When the access device 600 has been adjusted to have a desired length,the access device can be inserted into a patient's body to access asurgical region. The length of the access device 600 can also beadjusted while the access device is inserted into a patient.

Seventh Embodiment

FIGS. 9A to 9E illustrate another exemplary embodiment of a surgicalaccess device 700. The access device 700 can include an inner tube 702,an outer tube 704, and an auxiliary tool 706. As described in furtherdetail below, the length of the surgical access device 700 can beadjusted by moving the inner tube 702 proximally and distally relativeto the outer tube 704, and locking the position of the inner tube 702relative to the outer tube using the auxiliary tool 706.

As shown, the inner tube 702 and the outer tube 704 can include openingsor working channels formed therethrough, to and from their distal andproximal ends 702 d and 704 d, and 702 p and 704 p, respectively. Thecircumference of the opening of the outer tube 704 at the proximal end704 p can be larger than the circumference of an external wall of theinner tube 702 at the proximal end 702 p, such that the inner tube 702can be disposed within the outer tube 704 to form a telescoping,slidable engagement therebetween.

The proximal end 702 p of the inner tube 702 can include or can beformed into a cone-shaped portion or flange. The flange can serve as astop portion to prevent the distal movement of the inner tube 702,relative to the outer tube 704, beyond the inner tube's proximal end 702p. Such a flanging structure of the proximal end 702 p of the inner tube702 can also allow the proximal end of the inner tube 702 to bepositioned tightly on the surface of the skin of a patient when theaccess device 700 is inserted into the patient's body.

The inner tube 702 can include one or more ratchet features 705 disposedor formed on the length of the external surface of the inner tube 702.The ratchet features 705 can be disposed on diametrically opposed sidesof the external surface of the inner tube 702. The ratchet features 705can include a plurality of tooth features (705 t-1, 705 t-2, etc.;collectively referred to as “705-t”), which can define male engagementfeatures protruding from the external surface of the inner tube 702.

The tooth features 705 t of the ratchet 705 can be configured to engagewith or be received within a lip, groove, gap or other like structure709 formed in the internal surface of the outer tube 704, as describedin further detail below. The tooth features 705 t can be formed alongpart or the entire length of the inner tube 702. The tooth features 705t can be formed along part of the external surface of the inner tube 702starting at a lengthwise position proximate to the proximal end 702 p ofthe inner tube 702. The size and shape of the tooth features 705 t canvary. The distance or spacing between tooth features 705 t can be thesame or vary between each of the tooth features 705 t. The shape (e.g.,curve, square, triangle), thickness (e.g., amount of protrusion awayfrom the external surface), spacing and/or height (e.g., distancespanned across the length of the external surface of the inner tube 702by each tooth) of the tooth features 705 t can depend on the shape,thickness, distance and/or height of the lip 709 formed on the internalsurface of the outer tube 704 and vice versa. The width of the toothfeatures 705 t can be the same or vary between each of the toothfeatures, and they can spread over part or the entire circumference ofthe external surface of the inner tube 702.

The outer tube 704 can include an annular groove or lip 709 for engagingwith the ratchet 705 and/or its tooth features 705 t. As shown in FIGS.9A to 9D, the lip 709 can be provided around part or the entirecircumference of the internal surface of the outer tube 704. The lip 709can be formed at or proximate to the proximal end 704 p of the outertube 704, such that, when engaged with the inner tube 702, the resultinglength of the access device 700 can benefit from the rest of the lengthof the outer tube (e.g., from the lip 709 at the proximal end 704 p tothe distal end 704 d).

The lip 709 can engage with the tooth features 705 t to limit or preventdistal and proximal movement of the inner tube and the outer tube 702and 704 relative to each other. For example, the lip 709 can be aconcave feature such as a groove or gap formed on the internal surfaceof the outer tube 704, extending from the internal surface toward theexternal surface of the outer tube 704 such that the groove or gap is ofsufficient depth to accommodate part or all of a tooth feature 705 t. Inanother example, the lip 709 can be formed by the shape of the proximalend 704 p of the outer tube 704. For instance, when the proximal end 704p of the outer tube 704 has a cone shape, the internal surface of theouter tube 704 where the cone shape ends and meets the rest of theinternal surface of the outer tube can be convex and/or have a smallercircumference than the rest of the outer tube 704. This narrower orconvex portion of the internal surface of the outer tube 704 can beconfigured to have a circumference smaller than the circumference of theouter-most portion of the tooth features 705 t and larger than thecircumference of the external surface of the inner tube 702 at theregions between the tooth features 705 t. Such a configuration can allowthe narrower portion of the internal surface of the outer tube 704 to bereceived between two of the tooth features 705 t, fixing the position ofthe outer tube 704 and limiting or preventing the distal and proximalmovement of the inner and outer tubes 702 and 704 relative to oneanother when minimal or incidental force is applied in a proximal ordistal direction to the inner and/or outer tubes 702, 704.

To adjust the length of the access device 700 using the ratchetmechanism 705, force can be applied to the inner tube 702 and the outertube 704 in opposite distal or proximal directions. In other words,pulling the inner tube 702 away from the outer tube 704, pulling theinner tube 702 proximally and the outer tube 704 distally, or pushingthe inner tube 704 distally toward the outer tube 704, with sufficientforce, can cause the lip 709 on the internal surface of the outer tube704 to skip or slip past one or more of the tooth features 705 t. Thepulling and/or pushing of the tubes 702 and/or 704 can be repeated untilthe lip is fixedly engaged with one or more of the tooth features 705 tat a position where the access device 700 is at a desired length. Theamount of force needed to slip or skip the lip 709 past a tooth feature705 t can depend on various factors, including the size and/or shape ofthe lip 709 and/or tooth features 705 t, and/or the material of theinner and outer tubes 702 and 704.

An auxiliary tool 706 can be included in the access device 700 tofacilitate extension or retraction of the tubes 702, 704 relative to oneanother. The auxiliary tool 706 can be provided as a length-adjustmentfeature in addition or alternative to the ratchet 705. As shown in FIGS.9A to 9D, the auxiliary tool 706 can include a handle portion 707 on theproximal end 706 p of the auxiliary tool 706. The auxiliary tool 706 caninclude two prongs 710 (710-1, 710-2) that extend distally from thehandle 707. The distal end of the prongs 710 can include or can beformed as tabs 711 that curve or bend away from one another in aradially-outward direction. The length of the tabs (e.g., the distancethat the tabs 711 extend away from their respective prongs 710) andother of their dimensions (e.g., width, thickness) can be based on thethickness of the inner and outer tubes 702 and 704, and/or the size ofrespective slots 712 and 714 formed on the inner and outer tubes 702 and704. For example, the tabs 711 can be configured such that they canpenetrate through the slots 712 and 714.

The auxiliary tool 706 can be designed such that it is self-spreading,meaning that the prongs 710 are biased apart, e.g., by forming theauxiliary tool from a flexible and resilient material. In aconfiguration where the prongs 710 are biased apart, the distal ends ofthe tabs 711 can be separated, in their resting state, by a distancethat is larger than the diameter of the internal and external surfacesof the inner and outer tubes 702 and 704. The prongs 710 can be squeezedor compressed, against their bias, to narrow the distance separating theprongs 710 and/or the distal ends of the tabs 711. When squeezed, theprongs 710 and tabs 711 can be separated by a distance smaller than thediameter of the inner tube 702, such that the prongs 710 and 711 can bemoved through the inner tube 702 (and/or the outer tube 704), to beinserted through the slots 712 and 714.

The inner tube 702 can include one or more slots 712 (712-1, 712-2) thatpenetrate through the external surface and internal surface of the innertube 702. The number of slots 712 can correspond to the number of prongs710 or tabs 711 provided on the auxiliary tool 706. The slots 712 can beprovided on diametrically opposed sides of the inner tube 702, orotherwise to align with the tabs 711—e.g., so that when one of the tabs711 is positioned through one of the slots 712, another of the tabs 711can also extend through another of the slots 712 without manipulatingthe shape of the auxiliary tool 706. The slots 712 can be provided alongpart of the length of the inner tube 702. The slots 712 can extend froma region proximate to the proximal end 702 p toward the distal end 702d. The width of the slots 712 can be at least as large as the width ofthe tabs 711.

The outer tube 704 can include one or more slots 714 (714-1, 714-2) thatpenetrate through the external surface and internal surface of the outertube 704. The number of slots 714 can correspond to the number of prongs710 or tabs 711 provided on the auxiliary tool 706. The slots 714 can beprovided on diametrically opposed sides of the outer tube 704, orotherwise to align with the tabs 711—e.g., so that when one of the tabs711 is positioned through one of the slots 714, another of the tabs 711can also extend through another of the slots 714 without manipulatingthe shape of the auxiliary tool 706. The width of the slots 714 can bethe same as or similar to that of the slots 712, meaning at least aslarge as the width of the tabs 711. The length of the slots 714 (e.g.,the distance measured in a proximal to distal direction) can be smallerthan the length of the slots 712. The length of the slots 714 can beequal to or slightly larger than the thickness of the tabs 711 (e.g.,200%, 300%, 500%). While the slots 714 can be disposed anywhere alongthe length of the outer tube 704, in some embodiments, the slots 714 canbe formed proximate to the proximal end 704 p of the outer tube 704,such that the length of the access device 700 can be optimized.

To adjust the length of the access device 700 using the auxiliary tool706, the distal end 702 d of the inner tube 702 can be inserted withinthe opening at the proximal end 704 p of the outer tube 704. Theauxiliary tool 706 can be inserted within the inner tube 702. The slots712 and 714 of the inner and outer tubes 702 and 704 can be aligned withone another, such that the openings formed by the slots 712 and 714extend through the inner and outer tubes 702 and 704. Because the prongsand tabs 710 and 711 can be biased apart to a distance that exceeds thediameter of the opening of the inner tube, the prongs of the auxiliarytube 706 can be squeezed or compressed toward one another in order toinsert the auxiliary tool 706 into the opening of the inner tube 702.The prongs 710 can then released from their squeezed state, causing theprongs 710 and tabs 711 to spread apart, such that the tabs 711 extendor penetrate through the slots 712 and 714.

With the tabs 711 extending through the slots 712 and 714, the auxiliarytool 706 can be pulled or pushed proximally and distally, using thehandle 707, to adjust the length of the access device 700. Because theslots 714 are shorter than the slots 712, pulling or pushing theauxiliary tool 706 causes the proximal or distal surfaces, respectively,of the tabs 711 to engage with the proximal or distal surfaces of theslots 714 of the outer tube 706. Applying a pulling or pushing force onthe proximal or distal surfaces of the slots 714 using the tabs 711 cancause the outer tube 704 to move proximally or distally, respectively,relative to the inner tube 702 along the length of the slots 712. Whenthe inner and outer tubes 702 and 704 are positioned relative to oneanother such that a desired length of the access device 700 is achieved,the pulling or pushing of the auxiliary tool can be ceased. Theauxiliary tool 706 can thus be used to remotely or indirectly apply adistally-directing pushing force or a proximally-directing pulling forceto the outer tube 704 to move the outer tube axially relative to theinner tube 702. This can be particularly useful when adjusting thelength of the access device 700 while it is inserted into a patient,when the outer tube 704 may be disposed deep within the patient, may besurrounded with tissue, or may otherwise be in a position that makes itdifficult to manipulate directly. In use, the access device 700 can beadjusted to a first length and can be inserted through an incisionformed in the skin of the patient and advanced distally until the flangeon the proximal end of the inner tube 702 abuts the skin surface. Theauxiliary tool 706 can then be used to apply a distally-directed forceto the outer tube 704 to extend the length of the access device 700 to asecond length that is greater than the first length. For example, theouter tube 704 can be advanced distally until it bottoms out against abone surface or other target location. The auxiliary tool 706 can beremoved from the access device 700 to provide clear access through theworking channel of the access device, or can remain in place during thesurgery.

In embodiments in which the access device 700 is also equipped with oneor more ratchet features 705, the ratchet features can limit or preventdistal and proximal movement of the inner and outer tubes 702 and 704relative to one another. In another arrangement, the tabs of theauxiliary tool can engage ratchet teeth on the outer tube. Pulling thetabs radially-inward can disengage them from the ratchet teeth, allowingfor length adjustment. Releasing the tabs can allow them spring intoengagement with the teeth to limit or prevent length adjustment.

Eighth Embodiment

FIGS. 10A to 10C, and 11A to 11E illustrate another exemplary embodimentof a surgical access device 800. The access device 800 can include atube or main body having an opening or working channel formed from aproximal end 800 p to a distal end 800 d. Slits 802 can be formedlongitudinally through the body of the access device 800. The slits canpenetrate through the external and internal surfaces of the accessdevice 800. The slits 802 can extend from the proximal end 800 pdistally along the length of the access device 800 to an area prior tothe distal end 800 d. Bendable arms 804 can be formed longitudinally bythe body of the access device 800 positioned between two of the slits802. In other words, the bendable arms 804 can extend longitudinallyalong the length of the access device 800, from the proximal end 800 pand parallel to the slits 802. While the width of the slits 802 and thebendable arms 804 can vary, the width of the bendable arms 804 can belarger than the width of the slits 802. The bendable arms 804 can allowthe length of the access device 800 to be adjusted to a desired oroptimal length to reach or provide access to a surgical area in thepatient's body, as explained in further detail below.

To operate the access device 800 and adjust its length, the distal end800 d of the access device can be inserted into the patient's body to adepth sufficient or optimal to access the surgical area in the patient'sbody, as shown in FIG. 11A. When the access device 800 is so positioned,the bendable arms 804 extending from the proximal end 800 p of theaccess device 800 can be bent at or relative to a pivot point at orproximal to the surface of the patient's skin, as shown in FIG. 11C.

The access device 800 can include a support ring 806. The support ring806 can be slidably disposed around the external surface of the accessdevice 800, e.g., with sufficient friction such that the ring 806 cannotbe proximally or distally moved relative to the access device 800without applying force thereto. To facilitate the bending of thebendable arms 804, the ring can be inserted over the access device 800and slid along an exterior surface thereof to position the ring incontact with the skin surface, as shown in FIG. 11B, or at any otherdesired longitudinal position along the access device. The ring 806 canbe positioned such that its distal end is below the surface of thepatient's skin, and its proximal end is above the surface of thepatient's skin. The ring 806 can be positioned entirely beneath theskin, or can be spaced proximally from the skin. The bendable arms 804can be folded over the ring, allowing the arms to be more easily andevenly bent against the edge of the proximal side of the ring 806, asshown in FIG. 11C. With the arms 804 bent at or proximate to the surfaceof the patient's skin, distal movement of the access device 800 relativeto the patient's body can be prevented.

To stabilize the access device 800 and prevent its movement once thebendable arms 804 have been bent, one or more of the arms can beattached or affixed to the patient, e.g., to the skin of the patient.For example, an adhesive, tape, sutures, or other fixing tools ortechniques can be applied over one or more of the bendable arms 800, asshown in FIG. 11D. In some embodiments, as shown in FIG. 10A, a circularadhesive disc 808 can be placed over the bendable arms 800, such that anadhesive side of the disc 808 contacts the bendable arms 800 and thesurface of the patient's skin, thereby fixing them to one another. Theadhesive 808 can prevent distal or proximal movement, or rotation, ofthe access device 800 relative to the patient. The adhesive disc 808 caninclude a central opening to allow access to the working channel of theaccess device 800.

Additionally or alternatively, the access device 800 can be stabilizedto the patient, for example by securing the access device 800 to ananatomical structure of the patient or an implant implanted in thepatient. The anchor point can be remote from the access device. Theanchor point can be a bone anchor, such as a pedicle or lateral massscrew. The anchor point can be an extension tab or post 810 extendingproximally from a bone anchor implanted in the patient to a positionoutside the patient. The anchor point can be on an ipsilateral orcontralateral side of the spine from the access device 800. The anchorpoint can be a post 810 fixed to a patient's pedicle or other bone andthat penetrates through the patient's skin at a region sufficientlyclose to the access device 800 that the post can receive one or more ofthe bendable arms 804. The post 810 can be positioned such that abendable arm 804 can be folded over and positioned between opposed armsof the post, as shown in FIG. 10A. Securing the access device 800 canpreventing its radial movement or rotation, and otherwise maintain theaccess device at a fixed position and/or orientation with respect to thepatient. The opposed arms of the post 810 can be spaced apart from oneanother a distance that is larger than the width of the bendable arm804, such that the bendable arm 804 can be positioned in the spacebetween the arms. A set screw, fastener, or other closure mechanism canbe applied to the post 810 to secure the bendable arm therein. With thebendable arms 804 stabilized, the access device 800 can be operated withminimal or no movement or rotation relative to the patient's body.

Ninth Embodiment

FIG. 12 illustrates another exemplary embodiment of a surgical accessdevice 900. The surgical access device 900 can include an inner tube 902and an outer tube 904. The inner tube can include proximal and distalends 902 p and 902 d; and the outer tube can include proximal and distalends 904 p and 904 d. The inner tube 902 and the outer tube 904 can haverespective holes or working channels formed therethrough, from theirdistal to their proximal ends. The inner tube 902 can be slidablyengaged within the outer tube 904, such that the two are telescopicallymated.

The external surface of the inner tube 902 can include ribs or otherengagement features 906 wrapping around all or a part of thecircumference of the external surface of the inner tube 902. Theinternal surface of the outer tube 904 can include counterpart ribs orother engagement features 908 that wrap around all or a part of thecircumference of the internal surface of the outer tube 904. The ribbedfeatures 906 and 908 can be convex or concave structures, and the ribbedfeatures of the inner tube 902 can engage with the ribbed features ofthe outer tube 902. For example, convex ribbed features can engage withtwo opposing convex features (e.g., by being positioned between the twoconvex features), or can engage with an opposing and complementaryconcave feature (e.g., by being positioned within the concave feature).

The shape and size of the ribbed features 906 or 908 can be based on theshape and size of the opposite and complementary ribbed features 906 and908. For example, convex features can protrude, away from the externalsurface of the inner or outer tube 902 and 904, a distance equal to thedepth of a complementary concave feature, or a distance equal to theamount of protrusion of the complementary convex features. The shape,size, and/or material properties of the ribbed features can be selectedto allow the ribbed features 906 and 908 to skip or slip past or overeach other as the inner and outer tubes 902 and 904 are moved proximallyand distally relative to one another when opposite distal and proximalforces are applied to the inner tube 902 and the outer tube 904. Inother words, the ribbed features 906 and 908 can function like a ratchetby allowing the ribbed features to skip or slip one another whenproximal and/or distal force is applied to the inner and outer tubes 902and 904.

The proximal end 904 p of the outer tube can include attached thereto orformed thereon a collar or handle 910 portion that can enable the accessdevice 900 to be connected to an anchor or similar stabilization device.The anchor or stabilization device can have a fixed position relative toon object or the patient's body.

The length of the access device 900 can be adjusted prior to or duringthe access device 900 being inserted into the patient's body.

Tenth Embodiment

FIGS. 13A to 13C illustrate another exemplary embodiment of a surgicalaccess device 1000. The surgical access device 1000 can include a tubehaving a distal end and a proximal end 1000 d and 1000 p, respectively.A part of the tube can be formed from or can include a plurality ofsegments, such as segments 1002 a, 1002 b and 1002 c (collectively“1002”). As explained below, the segments 1002 can be attached and/ordetached from one another to achieve a tube of a desired or optimallength for surgery. The segment at the distal end 1000 d—namely segment1002 a in FIG. 13A, can be the longest of the segments and the one thatis to be inserted into the patient's body for surgery.

The segments 1002 can be attachable and detachable using film jointand/or snap fit features 1004 that connect two of the segments 1002. Thesnap fit features 1004 can include a protruding part 1004 p (e.g., hook,stud, bead) on one segment and a mating depression part (e.g., undercut)1004 d on the other segment. The protruding part and depression partscan be provided on either a distal or a proximal one of two segments.Two segments can be connected by one or more snap fit features 1004. Thelength of the protruding part can be configured to be long enough toreach the corresponding depression. The depth of the depression can belarge enough to accommodate the protruding part.

Two segments can be detached by pulling the two segments apart from eachother. The snap fit features 1004 can be configured such that apredetermined amount of force allows the two segments to be separatedwithout extreme or machine force being needed. The force to be appliedto separate two segments can be a pulling force away from the two partsof the snap features 1004, while pivoting at a diametrically opposed endof the two segments. Two segments can be attached by pushing the twosegments toward each other, such that the two parts of the snap fitfeatures 1004 can snap within one another.

When two segments are connected, the snap fit features can be configuredto create or maintain a smooth, constant external surface of the accessdevice 1000. Segments can be detached or attached as described aboveuntil a desired length of the access tube 1000 for surgery is achieved.The segments can be formed from a flexible or bendable material, suchthat the snap fit features are deformable during assembly or disassemblyto allow the segments to be attached or detached. The segments can beformed from a rigid material and can be permanently broken whenseparated from one another.

Eleventh Embodiment

FIG. 14 illustrates another exemplary embodiment of a surgical accessdevice 1100. The surgical access device 1100 can include a tube having adistal end 1100 d and a proximal end 1100 p. Part of the access device1100 proximate to the proximal end 1100 p can be circumferentiallycorrugated with bellows or accordion features 1102 similar to those of adrinking straw.

The length of the access device 1100 that is corrugated can vary asneeded to achieve a desired stability and length of the access device1000. Likewise, the inward depth and/or protrusion of the corrugationscan vary in order to achieve a desired strength of each corrugatedfeature, and/or to adjust the force needed to shorten and lengthen theaccess device 1000.

The access device 1000 can be lengthened by applying axial tension orpulling force to opposite sides of the corrugated features. The accessdevice 1000 can be shortened by applying axial compression or pushingforce to opposite sides of the corrugated features. The pulling andpushing forces can be repeated until the desired length of the accessdevice 1000 is achieved.

Twelfth Embodiment

FIGS. 15A and 15B illustrate another exemplary embodiment of a surgicalaccess device 1200. The access device 1200 can include two or more tubes1202 and 1204. The tubes 1202 and 1204 can be connected viainterdigitating fins or fingers 1202 f and 1204 f, respectively, asdescribed below. The fingers can engage one another with sufficientfriction to maintain the access device 1200 at a fixed overall lengthwhen subjected to forces typically associated with surgery through anaccess device. The length of the access device 1200 can be adjusted bysliding the proximal and distal tubes 1202, 1204 relative to one anotherto increase the engaged length of the fingers (and reduce the overalllength of the access device) or to decrease the engaged length of thefingers (and increase the overall length of the access device).

As shown in FIGS. 15A and 15B, the tubes 1202 and 1204 can haverespective distal ends (1202 d, 1204 d) and proximal ends (1204 p, 1204p). One or more of the ends of the tubes 1202 and 1204 can includecantilevered fingers 1202 f and 1204 f that extend from the other end ofthe tube. For instance, in FIG. 15B, the tube 1204 is shown. The distalend 1204 d can define a fully closed ring, from which the fingers 1204 fextend toward and/or to the proximal end 1204 p. The fingers 1204 f canextend from the distal end 1204 d or from an area between the distal end1204 d and the proximal end 1204 p.

The fingers 1204 f have a same size and shape as one another, and canhave the same size and shape as the spaces or gaps separating them.Likewise, the size and shape of the fingers 1202 f, and of the gapsseparating the fingers 1202 f, can match each other and the fingers 1204f. The fingers 1202 f and 1204 f can have a slightly different size thanthe gaps separating them, allowing the fingers of one of the tubes 1202and 1204 to slide within or between the gaps of the other tube 1202 and1204. The sizes and shapes can be configured such that a sufficientamount of surface area and associated friction between fingers of onetube and fingers of another tube can be achieved, to prevent the distaland proximal movement of the tubes 1202 and 1204 relative to one anotherwhen minimal or incidental force is applied thereto.

That is, the fingers and gaps of the tubes 1202 and 1204 can be designedsuch that they can engage with each other by sliding therebetween. Inother words, the fingers 1202 f of one tube 1202 can slide between thefingers 1204 f of the other tube 1204. The two tubes can be pulled fromand pushed toward one another to engage a shorter or larger length ofthe fingers 1202 f and 1204 f, until the desired length of the accessdevice 1200 is achieved.

The inner diameters or circumferences of the tubes 1202 and 1204 can bethe same. Thus, when the fingers 1202 f and 1204 f are engaged, theinner diameter or circumference of the access device 1200 can remainconstant throughout its length, forming a continuous and smooth internalsurface of the access device 1200. The outer diameters or circumferencesof the tubes 1202 and 1204 can be the same. Thus, when the fingers 1202f and 1204 f are engaged, the outer diameter or circumference of theaccess device 1200 can remain constant throughout its length, forming acontinuous and smooth external surface of the access device 1200.

The access device 1200 can advantageously maximize the working channelinside diameter available for a given external diameter and wallthickness of the access device. In other words, because the proximal anddistal tubes can have the same internal diameter and the same externaldiameter, space that would be otherwise occupied by one of the tubes ina telescoping-type access device is free to be used as part of theworking channel.

Connection Features

Any of the access devices described herein can include a connectionfeature. The connection feature can be used to secure the access devicerelative to the patient or another reference. The connection feature canbe a spherical body connected to the access device by a cantileveredbeam. The connection feature can be disposed adjacent a proximal end ofthe access device. The connection feature can be an external surface ofthe access device configured to be received between opposed jaws of aconnector or clamp. The connection feature can be a recess or cut-outformed in a sidewall of the access device.

FIG. 16 illustrates an exemplary embodiment of a connection feature 1302and counterpart connector. Any of the access devices described hereincan include the connection feature 1302

The connection feature can be defined by a cutout 1302 formed in asidewall of an access device 1300. The cutout 1302 can be open to aproximal end 1300 p of the access device and can extend toward a distalend of the access device. The cutout 1302 can penetrate from an externalsurface of the tube 1300 to the internal surface. The cutout 1302 caninclude a path or slot portion extending from the proximal end 1300 p,and a circular resting potion at the distal most end of the cutout. Thedistal portion of the cutout 1302 can have a chamfered or conicalbearing surface.

The cutout 1302 can be configured to receive a counterpart matingfeature of a connector or other support. The counterpart mating featurecan include a cone 1304 protruding from a cap 1306. The cone 1304 canhave a size and shape that enables the cone or a portion of the cone toslide within the cutout 1302. The cone 1304 can protrude from cap 1306 alength equal to the thickness of the body of the tube of the surgicalaccess device 1300. The cone 1304 can be extendable and retractable fromthe cap 1306, to allow the cone to be extended when being inserted intothe cutout 1302, and retracted to form a tight connection with the tube1300. The cone 1304 can be coupled to a wire or cable, and tension canbe applied to the cable to pull the cone 1304 towards the cap 1306 andinto firm engagement with the bearing surface of the cutout 1302. Thecone 1304 can taper at an angle that matches that of the chamferedportion of the cutout 1302. The cap 1306 can define a semi-cylindricalrecess sized to receive at least a portion of the exterior surface ofthe access device 1300 therein. The connection feature can form a“zero-profile” connection, such that no portion of the connectionfeature protrudes from an internal or external surface of the accessdevice 1300.

The cutout 1302 can be provided on one or more tubes of the accessdevices described herein. The cone and cap 1304 and 1306 can be adjustedto engage with multiple tubes simultaneously.

Any of the devices described herein can include access tubes that varyin structure or operation from what is shown. Any of the devices hereincan include an access tube in the form of a closed tubular body. Any ofthe devices herein can include an access tube in the form of amulti-bladed retractor. The retractor can be configured to radiallyexpand and/or contract. The retractor can include blades that can betoed inward or outward. Exemplary access devices that can be used with,or having features that can be included in, any of the devices hereinare described in U.S. Pat. No. 7,491,168, titled “Surgical RetractorSystems and Illuminated Cannulae,” issued on Feb. 17, 2009 which isincorporated herein by reference in its entirety. Any of the devicesherein can include an access tube that forms less than a full/closedcircle, or that has a non-circular transverse cross-section.

The devices herein can be used to deliver flowable material to a sitewithin a patient. The flowable material can be a hemostat. The flowablematerial can be a gelatin. The flowable material can be SURGIFLOhemostat matrix available from ETHICON. The devices herein can be usedto deliver a powdered material to a site within a patient. The powderedmaterial can be a powdered antibiotic, such as vancomycin. The powderedmaterial can be powdered pig bladder. The powdered material can beso-called “pixie dust” or “pixie powder.”

It should be noted that any ordering of method steps expressed orimplied in the description above or in the accompanying drawings is notto be construed as limiting the disclosed methods to performing thesteps in that order. Rather, the various steps of each of the methodsdisclosed herein can be performed in any of a variety of sequences. Inaddition, as the described methods are merely exemplary embodiments,various other methods that include additional steps or include fewersteps are also within the scope of the present disclosure.

The devices disclosed herein can be constructed from any of a variety ofknown materials. Exemplary materials include those which are suitablefor use in surgical applications, including metals such as stainlesssteel, titanium, nickel, cobalt-chromium, or alloys and combinationsthereof, polymers such as PEEK, ceramics, carbon fiber, and so forth.The various components of the devices disclosed herein can be rigid orflexible. One or more components or portions of the device can be formedfrom a radiopaque material to facilitate visualization under fluoroscopyand other imaging techniques, or from a radiolucent material so as notto interfere with visualization of other structures. Exemplaryradiolucent materials include carbon fiber and high-strength polymers.

The devices and methods disclosed herein can be used inminimally-invasive surgery and/or open surgery. While the devices andmethods disclosed herein are generally described in the context ofspinal surgery on a human patient, it will be appreciated that themethods and devices disclosed herein can be used in any type of surgeryon a human or animal subject, in non-surgical applications, onnon-living objects, and so forth.

While various example embodiments have been described above, it shouldbe understood that they have been presented by way of example, and notlimitation. It is apparent to persons skilled in the relevant art(s)that various changes in form and detail can be made therein. Thus, thedisclosure should not be limited by any of the above described exampleembodiments.

In addition, it should be understood that the figures are presented forexample purposes only. The architecture of the example embodimentspresented herein is sufficiently flexible and configurable, such that itmay be utilized and navigated in ways other than that shown in theaccompanying figures.

Further, the purpose of the Abstract is to enable the U.S. Patent andTrademark Office and the public generally, and especially thescientists, engineers and practitioners in the art who are not familiarwith patent or legal terms or phraseology, to determine quickly from acursory inspection the nature and essence of the technical disclosure ofthe application. The Abstract is not intended to be limiting as to thescope of the example embodiments presented herein in any way. It is alsoto be understood that the procedures recited in the claims need not beperformed in the order presented.

One skilled in the art will appreciate further features and advantagesof the disclosure based on the above-described embodiments. Accordingly,the disclosure is not to be limited by what has been particularly shownand described. All publications and references cited herein areexpressly incorporated herein by reference in their entirety.

1. An access device comprising, an upper tube having an opening formedtherethrough, the upper tube including: a proximal end configured toprevent proximal movement of a spring, the spring forming an openingthrough which the upper tube is disposed; and one or more fingers formedat a distal end of the upper tube and extending toward a proximal end ofthe upper tube, the one or more fingers having ribs formed on an innersurface thereof; a middle tube having an opening formed therethrough forslidably receiving the upper tube, the middle tube including a proximalend configured to apply force on the spring; and a lower tube slidablydisposed at least in part within the distal end of the upper tube andhaving an opening formed therethrough, the lower tube including groovesdisposed on at least a portion of an outer surface of the lower tube andconfigured to engage with the ribs on the inner surface of the one ormore fingers of the upper tube; wherein the middle tube is biased awayfrom the upper tube in a configuration in which the spring isuncompressed, causing the distal end of the middle tube to compress theone or more fingers of the upper tube and lock the position of the lowertube by engaging the ribs on the inner surface of the fingers with thegrooves on the outer surface of the lower tube, restricting the proximaland distal movement of the lower tube relative to the upper tube, andwherein the access device is actuated by proximally moving the middletube relative to the upper tube against the bias of the spring, causingthe one or more fingers to become exposed and move away from the lowertube, and enabling proximal and distal movement of the lower tuberelative to the upper tube.
 2. The access device of claim 1, wherein theopenings formed through one or more of the upper tube, the middle tubeand the lower tube are round, square or rectangular openings.
 3. Theaccess device of claim 1, wherein one or more of the upper tube, middletube and lower tube have round, square or rectangular shapes formed bytheir outer surfaces.
 4. The access device of claim 1, wherein, toprevent the proximal movement of the spring, the proximal end of theupper tube includes a stop portion having an outer surface with acircumference larger than a circumference of an adjacent portion of theupper tube, and wherein the stop portion is configured to preventproximal movement of the spring relative to the distal end of the uppertube, and to cause the spring to compress when force is applied theretoin a proximal direction by the proximal end of the middle tube.
 5. Theaccess device of claim 1, wherein the middle tube includes one or morehandles extending away from an outer surface of the proximal end of themiddle tube, and wherein the proximal movement of the middle tube iscaused by the application of force, in a proximal direction, on the oneor more handles.
 6. The access device of claim 1, wherein the one ormore fingers are defined by slits formed through the outer and innersurfaces of the upper tube at its distal end.
 7. The access device ofclaim 1, wherein the grooves on the inner surface of the fingers of theupper tube are configured to mate with the grooves on the outer surfaceof the lower tube, to restrict the proximal and distal movement of thelower tube relative to the upper tube.
 8. The access device of claim 1,wherein the size of the opening of the upper tube at its distal end whenthe fingers of the upper tube are compressed is smaller than or equal tothe size of the lower tube at its proximal end, and wherein the size ofthe opening of the upper tube at its distal end when the fingers ofupper tube are flanged is larger than the size lower tube at itsproximal end.
 9. The access device of claim 8, wherein the size of theopening of the middle tube is: (i) larger than the size of the uppertube at its distal end; (ii) larger than the size of the lower tube; and(iii) smaller than the size of the spring.
 10. The access device ofclaim 9, wherein a length of the access device is adjustably set by thelocked position of the lower tube in which its proximal and distalmovement relative to the upper tube is restricted by the engagement ofthe grooves on the inner surface of the fingers with the grooves on theouter surface of the lower tube.
 11. A method for operating an accessdevice, comprising: identifying a target depth required to access asurgical site in a patient's body; adjusting the length of a surgicalaccess device based on the identified target depth; and advancing adistal end of the surgical access device toward the surgical site in thepatient's body.
 12. The method of claim 12, wherein the adjusting of thelength of the surgical access device comprises: advancing the surgicalaccess device from a biased configuration to an actuated configuration,to allow distal and proximal sliding of a lower tube of the accessdevice relative to an upper tube of the access device; sliding the lowertube to a target position relative to the upper tube; and advancing thesurgical access device from the actuated configuration to the biasedconfiguration, to lock the target position of the lower tube relative tothe upper tube.
 13. The method of claim 12, wherein the advancing of thesurgical access device from the biased configuration to the actuatedconfiguration comprises: causing one or more fingers disposed on thedistal end of the lower tube to flange by applying one or more of (i)distal force on the upper tube, and (ii) proximal force on the middletube, against the bias of a spring positioned between a proximal end ofthe upper tube and a proximal end of the middle tube, causing the middletube to slide proximally toward the proximal end of the upper tube,wherein, in the actuated configuration, the flanged fingers have anopening configured to enable the lower tube to slide distally andproximally therein.
 14. The method of claim 13, wherein the advancing ofthe surgical access device from the actuated configuration to the biasedconfiguration comprises: releasing the distal force on the upper tube orthe proximal force on the middle tube, causing the spring to bias to itsuncompressed configuration and driving the middle tube distally awayfrom the proximal end of the upper tube, such that the fingers of theupper tube are compressed by the inner surface of the middle tube, andcausing grooves disposed on an inner surface of the fingers of the uppertube to mate with grooves disposed on an outer surface of the lower tubeto prevent the distal and proximal movement of the lower tube relativeto the upper tube.
 15. A surgical access device, comprising: an innertube; and an outer tube having a distal end and a proximal end, and ahole formed therethrough, the hole being configured to receive the innertube, wherein an external surface of the inner tube generates frictionwith the internal surface of the outer tube, and wherein movement of theinner tube distally and proximally relative to the outer tube isrestricted by the friction generated by the external surface of theinner tube with the internal surface of the outer tube.
 16. An accessdevice comprising: a tube having an opening formed therethrough from adistal end to a proximal end of the tube, the tube comprising one ormore sets of cut regions along an external surface of the tube forseparating the tube into a useable portion and a disposable portion,wherein the useable portion has a length configured to surgically accessan area of a patient's body.
 17. The access device of claim 16, whereinthe sets of cut regions comprise one or more perforations.
 18. Theaccess device of claim 17, wherein sets of cut regions are provided atfixed intervals along a portion of the length of the tube.
 19. Theaccess device of claim 18, wherein each of the sets of cut regions isprovided around the circumference of the external surface of the tube.20. The access device of claim 18, wherein each of the sets of cutregions is provided around less than the entire circumference of theexternal surface of the tube.
 21. The access device of claim 17, whereineach of the perforations penetrate through the tube from the externalsurface to the internal surface.
 22. A method of operating an accessdevice, comprising: identifying a target depth required to access asurgical site in a patient's body; adjusting the length of a surgicalaccess device based on the identified target depth; and advancing adistal end of the surgical access device toward the surgical site in thepatient's body.
 23. The method of claim 22, wherein the adjusting thelength of the surgical device comprises removing a disposable portion ofa tube of the surgical access device, by separating the disposableportion from the rest of the tube.
 24. The method of claim 23, whereinthe separating of the disposable portion comprises twisting, bending orapplying force against opposite sides of the tube of the surgical accessdevice relative to a fixed pivot point, and wherein the fixed pivotpoint is located at one of a set of cut regions disposed on the externalsurface of the tube.
 25. The method of claim 24, wherein the set of cutregions comprise one or more perforations.
 26. The method of claim 25,wherein the each of the sets of cut regions is provided around thecircumference of the external surface of the tube, and wherein each ofthe perforations penetrate through the tube from the external surface tothe internal surface.
 27. The access device of claim 17, furthercomprising: a ring portion comprising two or more concentric wallsextending from a proximal end to a distal end of the ring portion, thetwo or more concentric walls being separated by a space configured toreceive the proximal end of the tube.
 28. The access device of claim 27,wherein one of the two or more concentric walls includes one or moreteeth features angled facing the proximal end of the ring portion,wherein the one or more teeth are configured to penetrate the externalsurface of the proximal end of the tube when the ring portion is in amounted configuration, and wherein the ring portion is placed in themounted configuration by (i) sliding the tube between two of the two ormore concentric walls, one of which includes the one or more teethfeatures, from the distal end of the ring portion toward the proximalend of the ring portion, and (ii) pulling the tube from the proximal endof the ring portion toward the distal end of the ring portion, causingthe penetration of the one or more teeth into the external surface ofthe tube.
 29. The access device of claim 28, wherein the one of the twoor more walls including the one or more teeth features has the one ormore teeth features disposed on surface facing another of the two ormore concentric walls.
 30. The access device of claim 28, wherein thetwo or more concentric walls include an exterior wall, an interior walland a middle wall provided between the exterior wall and the interiorwall, and wherein the middle wall is the one of the two or moreconcentric walls that includes the one or more teeth features.
 31. Theaccess device of claim 30, wherein the one or more teeth features areprovided on an internal surface of the middle wall.
 32. The method ofclaim 22, further comprising: mounting a tube of the adjusted-lengthsurgical device onto a ring portion.
 33. The method of claim 32, whereinthe mounting of the tube onto the ring portion comprises: sliding theproximal end of the tube in a distal end of the ring portion, toward aproximal end of the ring portion, the proximal end of the tube beingslid between two walls of the ring portion; pulling the tube in adirection from the proximal end of the ring portion toward the distalend of the ring portion, wherein the pulling of the tube causes theteeth features disposed on a surface of a first wall among the two wallsto grip the tube by penetrating into and external surface of the tube,the teeth features being disposed on the surface of the first wallfacing a second wall among the two walls.
 34. The method of claim 33,further comprising: stabilizing the surgical access device advanced intothe surgical site of the patient's body by connecting a stabilizingfeature of the ring portion to a corresponding stabilizing feature on ananchor device.
 35. A surgical access device comprising: an inner tubehaving an opening formed therethrough and a knob protruding from anexternal surface of the inner tube; and an outer tube having an openingformed therethrough and one or more slots connected by a path, the oneor more slots and the path penetrating through an external and internalsurface of the outer tube and being operable to receive the knob of theinner tube, wherein rotating the inner tube in a first directionrelative to the outer tube causes the inner tube to be positioned in anadjustable-length configuration, in which the knob of the inner tube isslidably disposed along the path of the outer tube, and wherein rotatingthe inner tube in a second direction opposite the first directionrelative to the outer tube causes the inner tube to be positioned in afixed-length configuration, in which the knob of the inner tube isfixedly engaged within one of the one or more slots of the outer tube.36. The surgical access device of claim 35, wherein a proximal end ofthe inner tube comprises a handle, the handle being operable to controlthe rotating of the inner tube in the first and second directions. 37.The surgical access device of claim 35, wherein the opening of the outertube is configured to receive a first surgical tool, and wherein theouter tube further comprises a sub-tube protruding from the externalsurface thereof, the sub-tube being configured to receive a secondsurgical tool.
 38. The surgical access device of claim 35, wherein theinner tube in the adjustable-length configuration can be advanceddistally and proximally such that the knob slides along the path of theouter tube, and wherein fixing the knob of the inner tube in each of theslots of the outer tube causes the length of the surgical access deviceto be altered.
 39. A method for operating a surgical access device,comprising: identifying a target depth required to access a surgicalsite in a patient's body; adjusting the length of a surgical accessdevice based on the identified target depth; and advancing a distal endof the surgical access device toward the surgical site in the patient'sbody.
 40. The method of claim 39, wherein the adjusting the length ofthe surgical access device comprises: rotating an inner tube of thesurgical access device in first direction relative to an outer tube ofthe surgical access device, to position a knob protruding from anexternal surface of the inner tube within a path formed along the lengthof an outer tube, the inner tube being slidably engaged within the outertube; advancing the inner tube distally or proximally relative to theouter tube, such that the knob of the inner tube slides along the pathof the outer tube; rotating the inner tube in a second directionopposite the first direction relative to the outer tube, to position theknob of the inner tube within one of a plurality of slots formed alongthe length of the outer tube and extending from the path, wherein thepositioning of the knob of the inner tube within one of the plurality ofslots causes the proximal and distal position of the inner tube relativeto the outer tube to be fixed.
 41. A surgical access device comprising:an inner tube including one or more engagement features of a first typedisposed on an outer surface thereof; and an outer tube telescopicallymated with the inner tube, and including one or more engagement featuresof a second type formed at least on the inner surface thereof; whereinthe first type of engagement features and the second type of engagementfeatures are complementary to each other, and wherein a length of thesurgical access device is adjusted by one of: (i) rotating the innertube relative to the outer tube such that the one or more engagementfeatures of the inner tube slide along the corresponding one or moreengagement features of the outer tube, and (ii) applying oppositeproximal or distal forces on the inner tube and outer tube, therebycausing engagement features of the inner tube to slip from thecorresponding one or more engagement features of the outer tube toadjacent others of the one or more engagement feature of the outer tube.42. The surgical access device of claim 41, wherein the one or moreengagement features of the inner tube and the outer tube form obliqueangles relative a longitudinal axis of the inner tube and/or the outertube.
 43. The surgical access device of claim 41, wherein the one ormore engagement features of the inner tube and the outer tube are formedof a deformable material enabling their slipping therebetween.
 44. Thesurgical access device of claim 41, wherein the one or more engagementfeatures of the inner tube and the outer tube are formed around part orall of the circumference of the inner tube and the outer tube,respectively.
 45. A surgical access device comprising: an inner tubehaving a distal end, a proximal end, and an opening formed therethrough,the inner tube comprising one or more ratchet features disposed alongpart of a length of an exterior surface of the inner tube, the one ormore ratchet features comprising one or more tooth features; and anouter tube having a distal end, a proximal end, and an opening formedtherethrough, the opening at the proximal end of the outer tube beingconfigured to receive the distal end of the inner tube, and the outertube comprising a lip feature formed around the circumference of theproximal end of the outer tube, the lip feature being configured toengage with one or more of the tooth features of the one or more ratchetfeatures of the inner tube, wherein a length of the surgical accessdevice is adjusted by applying opposite proximal and distal forces onthe inner and outer tubes causes the lip feature of the outer tube toslip over one or more of the tooth features of the one or more ratchetfeatures of the inner tube.
 46. The surgical access device of claim 45,wherein engaging the lip feature of the outer tube with one or more ofthe tooth features of the inner tube causes the distal and proximalmovement of the inner and outer tube, relative to each other, to berestricted.
 47. The surgical access device of claim 45, wherein theproximal end of the inner tube is cone-shaped and flanges proximally andexternally relative to the rest of the of the inner tube, and whereinthe external surface of the cone shaped portion of the inner tube isconfigured to contact a surface of skin of a patient's body when thesurgical access device is inserted in the patient's body.
 48. Thesurgical access device of claim 46, wherein a circumference of theinternal surface of the outer tube at the lip feature is smaller than acircumference of the external surface of the inner tube at the one ormore tooth features.
 49. The surgical access device of claim 45, furthercomprising an auxiliary tool comprising a handle portion formed at aproximal end thereof, two or more prongs, and two or more tabs formed atcorresponding distal ends of the two or more prongs, and the two or moreprongs biased apart from one another, wherein the inner tube comprisesone or more slots formed along part of the length of the inner tube,through the external and internal surfaces of the inner tube, whereinthe outer tube comprises one or more slots formed along part of thelength of the outer tube, through the external and internal surface ofthe outer tube, the one or more slots of the outer tube being shorterthan the one or more slots of the inner tube, and wherein the auxiliarytool is engaged with the inner and outer tubes by squeezing the two ormore prongs against their bias, proximally and distally moving theauxiliary tool along the opening of the inner tube, and releasing thetwo or more prongs causing their tabs to extend through the one or moreslots of the inner tube and the one or more slots of the outer tube. 50.The surgical access device of claim 49, wherein the length of thesurgical access device is adjusted by proximally pulling or distallypushing the auxiliary tool when the tabs are extending through the oneor more slots, causing distal or proximal force to be applied on the oneor more slots of the outer tube and the distal and proximal position ofthe outer tube relative to the inner tube to change as the tabs slidealong the one or more slots of the inner tube.
 51. The surgical accessdevice of claim 49, wherein the proximal pulling or the distal pushingof the auxiliary tool causes the lip feature of the outer tube to slipover one or more of the tooth features of the inner tube.
 52. A methodfor adjusting a length of a surgical access device, comprising: applyingopposite distal and proximal forces on an inner tube and an outer tubeof the surgical access device, the inner tube being slidably disposedwithin an opening of the outer tube, wherein the applying of theopposite distal and proximal forces causes a lip feature on an internalsurface of a proximal end of the outer tube to slip past one or moretooth features of one or more ratchet features formed on an externalsurface of the inner tube; and terminating the opposite distal andproximal forces on the inner tube and the outer tube when the lipfeature of the outer tube is engaged with one or more of the toothfeatures at a position in which the length of the surgical access deviceis equal to a desired length.
 53. A method for adjusting a length of asurgical access device, comprising: applying distal or proximal force onan auxiliary tool positioned within an opening formed through an innertube, the auxiliary tool comprising two or more prongs and or two ormore corresponding tabs extending outwardly from distal ends of the twoor more prongs through two or more slots formed through the inner tubeand two or more slots formed through the outer tube, the two or moreslots formed through the outer tube being shorter than the two or moreslots formed through the inner tube, wherein applying the distal orproximal force on the auxiliary tool causes the two or more tabs to pushor pull, respectively, against distal or proximal edges of the slots,such that the outer tube slides distally or proximally relative to theinner tube as the two or more tabs move distally or proximally along theone or more slots of the inner tube.
 54. The method of claim 53, whereinthe applying the distal or proximal force on the auxiliary tool furthercauses a lip feature formed on an internal surface of a proximal end ofthe outer tube to skip over one or more tooth features of one or moreratchet features formed on an external surface of the inner tube. 55.The method of claim 54, wherein the distal and proximal movement of theouter tube relative to the inner tube is restricted when the lip featureof the outer tube is engaged with one or more of the tooth features ofthe inner tube.
 56. The method of claim 53, wherein the auxiliary toolis positioned within the opening of the inner tube by: inwardlysqueezing the two or more prongs against their bias, such that thedistance between the two or more prongs is less than the diameter of theopening of the inner tube; distally or proximally moving the auxiliarytool within the opening of the inner tube; and releasing the two or moreprongs such that their bias causes the two or more tabs of the two ormore prongs to separate and extend through the two or more slots formedin the inner tube and the two or more slots formed in the outer tube.57. A surgical access device, comprising: a tube-shaped body having anexternal surface and an internal surface, the internal surface formingan opening through the surgical access device from a distal end to aproximal end; a plurality of longitudinal slits formed through the body,extending distally from the proximal end; and a plurality of bendablearms formed longitudinally through the body of the surgical accessdevice, extending distally from the proximal end, each of the pluralityof bendable arms being defined by two of the plurality of slits, whereinthe plurality of bendable arms are configured to be externally bentrelative to a pivot point to adjust the length of the access device. 58.The surgical access device of claim 57, further comprising a ringwrapped around the external surface of the body, wherein the pluralityof bendable arms are bent over a proximal end of the ring.
 59. Thesurgical access device of claim 57, further comprising a stabilizationmaterial for fixing the position of the plurality of bendable arms onskin of a patient, the stabilization material comprising one or more ofsutures, adhesive or tape.
 60. The surgical access device of claim 57,wherein at least one of the plurality of bendable arms engages with oneor more posts having a fixed position relative to the body of a patient,the posts restricting the rotation of the one of the plurality ofbendable arms.
 61. A method for adjusting a length of a surgical accessdevice, comprising: inserting a distal end of a surgical access deviceinto a body of a patient, the surgical access device having atube-shaped body; sliding a support ring distally along the body of thesurgical access device such that a proximal end of the support ring ispositioned above the surface of the skin of the patient; and bending oneor more bendable arms against the proximal end of the support ring suchthat external surfaces of the one or more bendable arms are placed incontact with the skin of the patient, wherein the one or more bendablearms are formed longitudinally along the body of the surgical accessdevice, extending distally from the proximal end of the surgical accessdevice, the one or more bendable arms being separated by slitspenetrating through the body of the surgical access device.
 62. Themethod of claim 61, wherein the one or more bendable arms are secured toskin using a stabilization object including one or more of an adhesive,tape and sutures.
 63. The method of claim 61, wherein at least one ofthe one or more bendable arms are positioned between two or more postshaving a fixed position relative to the body of the patient, such thatrotation of the at least one of the one or more bendable arms isprevented.
 64. A surgical access device comprising: an inner tube havinga distal end and a proximal end, a hole formed therethrough from thedistal end to the proximal end, and one or more first ribbed featureswrapped around the circumference of at least part of an external surfaceof the inner tube; and an outer tube having a distal end and a proximalend, a hole formed therethrough from the distal end to the proximal end,and one or more second ribbed features wrapped around the circumferenceof at least part of an internal surface of the outer tube, the outertube having the inner tube slidably engaged therein, wherein the one ormore first ribbed features are configured to engage with the one or moresecond ribbed features, and wherein a length of the surgical accessdevice is adjusted by applying opposite distal and proximal forces onthe inner and outer tubes such that at least one of the one or morefirst ribbed features slips over at least one of the one or more secondribbed features.
 65. The surgical access device of claim 64, wherein thedistal and proximal positions of the inner and outer tube, relative toeach other, are fixed when the one or more first ribbed features areengaged with the one or more second ribbed features.
 66. The surgicalaccess device of claim 65, wherein the one or more first ribbed featuresand the one or more second ribbed features are convex or concavestructures.
 67. The surgical access device of claim 66, furthercomprising a collar feature operable to connect to a stabilizationobject having a fixed position relative to a body of a patient or anobject.
 68. A method for adjusting the length of a surgical accessdevice, comprising: applying a force to a first tube of the surgicalaccess device, the force being a distal or proximal force relative to asecond tube of the surgical access device; causing one or more ribbedfeatures of the first tube to slide past one or more ribbed features ofthe second tube; and releasing the force applied to the first tube whenthe first tube has reached a position, relative to the second tube, inwhich a length of the surgical access device is equal to a targetlength.
 69. The method of claim 68, wherein the first tube is an innertube having the one or more ribbed features formed on an externalsurface thereof, wherein the second tube is an outer tube having the oneor more ribbed features formed on an internal surface thereof, the outertube having the inner tube slidably engaged therein.
 70. The method ofclaim 69, wherein the one or more ribbed features of the inner tube arecomplimentary to the one or more ribbed features of the outer tube, suchthat distal and proximal movement of the inner and outer tubes relativeto each other is prevented when they one or more ribbed features of theinner tube are engaged with the one or more ribbed features of the outertube.
 71. A surgical access device, comprising: a tube including aplurality of tube segments connected by interlocking snap features, thesnap features including a protruding feature and a depression feature,wherein each of the plurality of tube segments includes at least one ofa protruding feature and a depression feature, wherein at least one ofthe plurality of tube segment includes a protruding feature, and anotherof the plurality of tube segments adjacent to the one of the pluralityof tube segments includes a depression feature, and wherein the one ofthe plurality of tube features and the adjacent tube feature areattached to one another by the protruding feature of the one tubesegment being engaged with the depression feature of the adjacent tubesegment.
 72. The surgical access device of claim 71, wherein one tubesegment is detachable from the adjacent tube segment by disengaging theprotruding feature of the one tube segment from the depression featureof the adjacent tube segment.
 73. The surgical access device of claim72, wherein the protruding feature of the one tube segment is disengagedfrom the depression feature of the adjacent tube segment by applying aforce to the protruding feature in a direction away from the depressionfeature.
 74. A surgical access device, comprising: a tube having adistal end and a proximal end, and corrugated features along a portionof a length of the tube, the corrugated features being configured to bepulled and pushed to extend and retract the length of the tube.
 75. Thesurgical access device of claim 74, wherein the corrugated features areprovided adjacent to the proximal end of the tube.
 76. A surgical accessdevice, comprising: a first tube having a proximal end and a distal end,the first tube including fingers extending from the proximal end to thedistal end; a second tube having a proximal end and a distal end, thesecond tube including fingers extending from the distal end to theproximal end, wherein the fingers of the first tube and the fingers ofthe second tube being are spaced part from each other, and wherein thefingers of the first tube are configured to engage with the fingers ofthe second tube to fix the position of the first tube relative to thesecond tube.
 77. The surgical access device of claim 76, wherein thesize, shape and position of the fingers of the first tube is equal tothe size, shape and position of the fingers of the second tube.
 78. Thesurgical access device of claim 77, wherein the fingers of the firsttube distally and proximally slide between the fingers of the secondtube.
 79. The surgical access device of claim 78, wherein thecircumference of the first tube is equal to the circumference of thesecond tube.
 80. The method of claim 11, further comprising: deliveringa material to the surgical site through an opening formed through thesurgical access device, the material including one or more of: (i) aflowable material selected from the group consisting of hemostat andgelatin, and (ii) a powdered material selected from the group consistingof powdered pig bladder, pixie dust, and pixie power.